B_-_Tab_1a_-_Attachment_2.pdf

Attachment 2

CBP Past Performance Questionnaire

Evaluator:__________________________________ (Name of Firm Providing Evaluation) Offeror: ___________________________________ (Name of Firm being evaluated)

U.S. Customs and Border Protection (CBP) is in the process of acquiring forensic urinalysis in support of its Drug Free Federal Workplace Program, mandated under provisions of Executive Order 12564. This service requires testing as governed by the U. S. Department of Human and Health Services (HHS) mandatory guidelines:

Testing and services include:

Immunoassay Gas Chromatography / Mass Spectrometry Documentation for Positive Test Results Transfer Split Specimen Reconfirmation testing by secondary laboratory Expert testimony Travel

Evaluation of an Offeror’s Past Performance on contracts for similar past or current/ongoing work is called for in selecting a firm for the proposed contract. An Offeror (named above) has submitted this form to you for your consideration and completion in its behalf. Completion and submission of this questionnaire form will aid us in making our determination.

Questionnaire Instructions:

The questionnaire covers several topics designed to provide basic information regarding the Contractor’s background and capabilities and your satisfaction with their performance.

Section I:

For each of the questions in this section, the evaluator is requested to use the following five-point scale with five (5) being Exceptional and one (1) being Unsatisfactory (see below). Exceptional is defined a performance meets all contractual requirements and exceeds many. Very Good is defined as performance meets all contractual requirements and exceeds in few. Satisfactory is defined as performance, which meets contractual requirements. Marginal is defined as performance, which meets some contractual requirements, but fails to meet others.

Unsatisfactory is defined as performance that does not meet most contractual requirements and recovery is not likely in a timely manner.

Exceptional = 5 Very Good = 4 Satisfactory = 3 Marginal = 2 Unsatisfactory = 1 Unknown = NA

Please CIRCLE your response below each question using the above scale:

How would you rate the offeror’s:

1. Ability to provide all necessary and accurate collection supplies to include chain custody forms?

5 4 3 2 1 NA

2. The capability to delivery specimen collection and shipping supplies within a specified time frame?

5 4 3 2 1 NA

3. The capability to validate and screen a minimum of 400 specimens in one calendar day?

5 4 3 2 1 NA

4. The capability to maintain the Department of Health and Human Services, professional, and regulatory credentials for at least two consecutive years prior to this solicitation?

5 4 3 2 1 NA

5. The ability to provide expert testimony?

5 4 3 2 1 NA

6. The capability to prepare “Litigation Package” (documentation for positive results) within a specified time frame?

5 4 3 2 1 N/A

Section II.

1. Would you hire this contractor again?

YES NO Why or Why not?

2. Description of Offeror’s project/contract on which this evaluation is based:

3. Project/contract magnitude (circle appropriate response):

Less than $25,000 Between $25,000 and $100,000 Between $100,000 and $250,000 Between $250,000 and $500,000 Between $500,000 and $1,000,000 Between $1,000,000 and $5,000,000 Between $5,000,000 and $10,000,000 More than $10,000,000.

4. Place of performance:

5. Date of start up ________________ and completion date ______________ of project/contract described above.

6. Role played by evaluator in the project/contract described above:

7. Name and title of evaluator:

8. Phone #: _______________________________________

Fax #: _________________________________________

9. Email: _________________________________________

10. Signature: ______________________________________

Date: ________________________

Note: This completed questionnaire and the name of the evaluator will not be provided to the offeror, however, the offeror may be permitted an opportunity to address any adverse information provided by the evaluator.

Upon completion of the questionnaire, the evaluator is requested to submit it directly to the Contracting Officer electronically, either by email using lloyd.burton@dhs.gov or via Fax, #817- 545-1288. Please do not send this form to the offeror.

mailto:lloyd.burton@dhs.gov

YES NO Why or Why not? _____________________________________________________________________________