Past_Performance_Questionnaire_final.doc

FDA-SOL-1116253

Attachment 1

Past Performance Questionnaire

NOTE: Offeror to insert information where there is (text surrounded by parentheses)

1.

General Instructions

Please complete this questionnaire. Electronic submission is preferred; however, written response submissions are sufficient with the technical/business proposal submission. If you need more space than provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information. Email or mail the completed questionnaire to:

FDA/ OAGS/FSB

ATTN: Tomeka Evans 5630 Fishers Lane, RM 2141

Rockville, MD 20857

Phone: 301-827-7168 Tomeka.Evans@fda.hhs.gov

2.

Explanation of Codes

CODE

PERFORMANCE LEVEL

E EXCEPTIONAL: Performance meets contractual requirements and exceeds many requirements to the Government's benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD: Performance meets contractual requirements and exceeds some requirements to the Government's benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY: Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL: Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

N NOT APPLICABLE: Unable to provide a score. Performance in this area is not applicable to effort assessed.

P Proprietary: The answer will lead to release of proprietary data and cannot be provided.

3.

Offeror Provided Information

Contract Identification: (to be completed by offeror proposing on this RFQ)

A. Contractor: ______________________________________________

B. Contract Number: __________________________________________

C. Order Number (if applicable):______________________________

D. Contract Type (Fixed Price/Cost): _________________________

E. Period of Performance: ____________________________________

F. Original Contract Amount: _________________________________

H. Final Contract Amount: ____________________________________

I. Description and Nature of Major Contract Modifications:

J. Description and/or Service Provided:

4.

Reference Provided Information

AGENCY/COMPANY NAME AND LOCATION:

Circle the appropriate letter for each item on the questionnaire and provide supporting narrative.

a. What is your overall rating of the contractor's performance?

E V S M U N P

Comments:

b. Given the choice, would you award to this contractor again?

(Y/N)

Comments:

SECURITY

c. Rate the contractor's ability to obtain required security clearances for qualified personnel?

S M U N P

Comments:

TIMELINESS

d. To what extent did the contractor adhere to contract delivery schedules?

S M U N P

Comments:

e. To what extent did the contractor submit required deliverables in a timely manner?

S M U N P

Comments:

CONTINUITY OF SERVICES

f. Rate the contractor's ability to recruit and retain qualified personnel.

S M U N P

Comments:

g. Contractor's personnel maintained current skills, certifications, and education for required positions.

E V S M U N P

Comments:

MANAGEMENT PLAN

h. Rate the contractor's ability to provide personnel with current industry knowledge, skills, and certifications.

S M U N P

i. Rate the contractor's ability to successfully manage cost, schedule, performance, personnel, and completion of all required tasks.

S M U N P

Comments:

QUALITY

j. To what extent were the contractor’s deliverables accurate and complete?

S M U N P

k. To what extent was the contractor able to solve contract performance problems without extensive guidance from Company/Government counterparts?

S M U N P

l. To what extent did the contractor display initiative in meeting requirements?

S M U N P

Comments:

BUSINESS RELATIONS

m. To what extent did the contractor commit adequate resources to the contract in a timely fashion in order to meet the requirements and to successfully solve problems?

E V S M U N P

Comments:

n. To what extent did the contractor ensure communication with all stakeholders in a timely manner?

E V S M U N P

Comments:

o. To what extent did the contractor respond positively and promptly to technical directions, evolving business requirements and contract modifications, etc.?

E V S M U N P

Comments:

p. To what extent was the contractor effective in interfacing with the Company/Government’s staff?

E V S M U N P

Comments:

SUBCONTRACTOR MANAGEMENT

q. To what extent did the contractor coordinate, integrate, and provide for effective subcontractor management?

E V S M U N P

Comments:

CONTRACTOR'S COST CONTROL

r. Contractor's cost control. Rate the contractor's ability to deliver at the agreed-to price/cost? Describe the reasons for changes to contract value (e.g., scope changes, overrun/under-run, Government or Commercial-imposed schedule changes, etc.)

E V S M U N P

Comments:

SAFETY AND HEALTH

s. Did the contractor experience any on-the-job accidents or OSHA violations?

( ) Yes ( ) No

If yes, explain the circumstances involving the incidents?

PROBLEM RESOLUTION

t. Has the contractor suggested alternative approaches to problems/issues?

E V S M U N P

Comments:

TERMINATIONS

u. Has this contract been partially or completely terminated for default or convenience?

( ) Default ( ) Convenience

If yes, explain (e.g., inability to meet cost, performance, or delivery schedule):

v. Are there any pending terminations?

If yes, explain and indicate the status:

Please provide the name, title, address, and phone number of the person completing this questionnaire.

Name:

Title:

Address:

Date:

Telephone:

Thank you for your assistance in this source selection. If you have any questions, please contact Tomeka Evans via e-mail at Tomeka.Evans@fda.hhs.gov or by phone (301) 827-6791.