A23_Attachment_5_-_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Instructions to Offerors Sending Reference Questionnaire Forms:

The Government is requesting that the offeror provide up to three (3) past performance contract references that reflect recent and relevant experience. Section A shall be completed by the Offeror (the firm requesting the reference) prior to issuing the questionnaires. The Offeror shall send the questionnaires for relevant projects completed in the past three (3) years of the proposal due date with twelve (12) months of the period of performance completed for the individuals who will provide the reference. For Government contracts, send to the Contracting Officer or Technical Representative. For commercial references, send to personnel with duties similar to those for Government contracts. It is the responsibility of the offeror to follow-up and encourage references to submit the questionnaire. The completed questionnaire shall be submitted via e-mail directly from the person providing the reference.

Instructions to Person Providing Reference:

In order to assess potential vendors under the Washington Headquarters Service / Acquisition Directorate (WHS/AD), Facilities Services Directorate (FSD) Nursing Mothers and Foreign Gifts Programs Logistics and Program Management Support Services, Solicitation Number HQ0034-19-R-0202, WHS is obtaining past performance information with respect to each Offeror. As a reference for work performed by the firm identified in Section “A” of this questionnaire, your candid response will assist in the evaluation process. Please complete Section “B” of the questionnaire as thoroughly as possible. The questionnaire must be submitted to whs.mc-alex.ad.mbx.ks@mail.mil, and CC: Aubrey J. McKinney, Contract Specialist, aubrey.j.mckinney2.civ@mail.mil by August 29, 2019, 10:00 AM, Eastern Standard Time (EST). The subject line in the submission e-mail shall clearly indicate: FSD Nursing Mothers and Foreign Gifts Programs Past Performance Questionnaire Submission for <Company Name> and the message shall originate from the reference’s government or commercial e-mail system.

In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. Your input into this evaluation is greatly appreciated, if you have questions regarding this questionnaire or require assistance, please submit inquiries WHS.MC-ALEX.ad.mbx.KS@mail.mil.

Sincerely, Karen A. Jones Contracting Officer

SECTION A

TO BE COMPLETED BY OFFEROR (THE FIRM

REQUESTING THE REFERENCE)

PART I: HQ0034-19-R-0202 - FSD Nursing Mothers and Foreign Gifts Programs Logistics and Program Management Support Services OFFEROR INFORMATION

COMPANY NAME AND DIVISION NAME OF OFFEROR:

OFFEROR ADDRESS:

OFFEROR DUNS:

PART II: PAST PERFORMANCE INFORMATION

TITLE OF PROJECT/CONTRACT NUMBER FOR WHICH REFERENCE IS REQUESTED:

PROCUREMENT VEHICLE (e.g. CONTRACT/ORDER/SUBCONTRACT/OTHER):

TYPE OF CONTRACT (e.g. NEGOTIATED, SEALED BID):

PRICING TYPE: (Check all that apply)

FP FPI CPFF CPAF CPIF IDIQ BOA

Requirements Labor-Hour T&M Other (Specify)

DATE OF AWARD:

PERIOD OF PERFORMANCE (INCLUDING OPTIONS):

CONTRACT AMOUNT:

• INITIAL CONTRACT DOLLAR VALUE(W/OPTIONS):

• FINAL CONTRACT DOLLAR VALUE(W/OPTIONS):

ROLE ON PROJECT:

PRIME

SUBCONTRACTOR (EXPLAIN TYPE AND EXTENT OF

SUBCONTRACTING, IF APPLICABLE): OTHER (EXPLAIN)

GENERAL DESCRIPTION OF TYPE OF SERVICES/PRODUCTS REQUIRED UNDER THE

CONTRACT:

DESCRIBE COMPLEXITY OF WORK:

SECTION B

TO BE COMPLETED BY EVALUATOR (PERSON

PROVIDING REFERENCE)

PART I: REFERENCE INFORMATION

NAME & TITLE:

ORGANIZATION (INCLUDING AGENCY AND/OR COMPANY):

CONTRACT ROLE (e.g. CO, COR, PM):

ADDRESS:

PHONE NUMBER:

FAX NUMBER:

E-MAIL:

PART II: INFORMATION ABOUT PROJECT/CONTRACT FOR WHICH REFERENCE IS

REQUESTED

Please identify and correct any information that is not accurate in Section A.

Please objectively assess the requesting firm in each performance element below by assigning an “X” to the most appropriate rating:

• Exceptional: Performance meets contractual requirements and exceeds many to the

Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

• Very Good: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

• Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

• Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

• Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance Element

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

1. QUALITY OF

PRODUCT OR

SERVICE Assess the contractor’s performance to contract requirements, specifications, and standards of good workmanship (e.g.

commonly accepted technical, professional, environmental, or safety and health standards).

Comments:

Performance Element

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

2. SCHEDULE

Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g. efforts that contribute to or affect the schedule).

3. BUSINESS RELATIONS

Assess the integration and coordination of all activities needed to execute the contract, specifically the timeliness, completeness, and quality of problem identification, corrective action plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award, and management of subcontractors.

4. MANAGEMENT OF

KEY PERSONNEL Assess the contractor’s performance in selecting, retaining, supporting, and replacing, when necessary, key personnel.

7. Comments:

8. Additional comments you would like to share

Signature/Date