Attachment 6 - Past Performance Questionnaire 07-12-2010.doc
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- Solicitation number
- HSCESS-10-R-00001
- Issued by
-
Immigration and Customs Enforcement
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Past Performance Questionnaire
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PAST PERFORMANCE QUESTIONNAIRE
PART ONE: INSTRUCTIONS
The company who has provided you with this form is responding to an Immigration and Customs Enforcement (ICE) RFP Number HSCESS-10-R-00001 for Medical, Psychological, Fitness, and Drug Testing. Past Performance is an extremely important part of the evaluation criteria for this acquisition, so your input is very important. The information is to be provided directly to the Contract Specialist, Juanita Jones, at the address listed below. This information will not be disclosed to the offeror. Please provide an honest assessment and return the questionnaire to ICE by email or fax (email preferred) to the address shown below, no later than August 13, 2010 at 2:00 p.m. Eastern Time.
Immigration and Customs Enforcement
Attn: Juanita Jones Contract Specialist 801 I Street, NW, Room 980-33 Washington, DC 20536
Juanita.Jones1@dhs.gov Carmen.Rios1@dhs.gov Fax: (202)732-7201 Phone: (202) 732-2619
PART TWO: GENERAL INFORMATION
1. OFFEROR’S NAME AND ADDRESS
2. CUSTOMER ORGANIZATION
3. CONTRACT NUMBER:
2a. EVALUATOR
4. CONTRACT VALUE (Circle One):
NAME:
<$25K $25K - $100K >$500K
TITLE:
PHONE NO:
5. CONTRACT AWARD DATE:
6. CONTRACT COMPLETION DATE:
7. CONTRACT TYPE (Circle All That Apply):
8. COMPLEXITY OF WORK (Circle
One Response):
FP
CPFF
CPAF
OTHER
DIFFICULT
ROUTINE
PART TWO: GENERAL INFORMATION CONTINUED
9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:
PART THREE: OFFEROR PERFORMANCE RATING
On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set of sub factors with five possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this offeror and indicate your assessment by placing an “X” under the appropriate heading. Offeror performance factors are:
A. QUALITY OF SERVICE
B. CONTRACT PERFORMANCE
C. TIMELINESS OF PERFORMANCE
Adjectival ratings are defined below and should be used as a reference in assessing performance:
| Exceptional |
| Contractor’s performance significantly exceeded most or all contract requirements. The contractual performance of the element or sub-element being assessed 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 assessed 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 assessed 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 serious problems(s) for which the Contractor’s corrective actions appear or were ineffective. |
| A |
| QUALITY OF GOODS/SERVICES |
| E |
| VG |
| S |
| M |
| U |
| 1 |
| Rate the overall quality of the services received. |
| 2 |
| Company’s handling of issues or problems. |
| B |
| CONTRACT PERFORMANCE |
| E |
| VG |
| S |
| M |
| U |
| 1 |
| Was the contractor able to solve contract performance problems without extensive guidance from counterparts? |
| 2 |
| How effective has the contractor been in understanding and responding to additional user requirements? |
| 3 |
| Did the contractor establish and maintain effective quality control standards and procedures? |
| C |
| TIMELINESS OF PERFORMANCE |
| E |
| VG |
| S |
| M |
| U |
| 1 |
| Were the services provided according to contract requirements? |
| 2 |
| Delivery of reports or other documentation? |
PART THREE: OFFEROR PERFORMANCE RATING
1.
Has this contract been partially or completely terminated for default or convenience?
YES
Default
Convenience
NO
If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules -also include contract number, name, address, and phone number of Terminating
Contracting Officer - TCO).
2.
What was the contractor’s greatest strength in the performance of the contract?
3.
What was the contractor’s greatest weakness in the performance of the contract?
4.
Would you award another contract to this contractor?
YES
No
COMMENTS:
PART FOUR: EVALUATOR’S CERTIFICATION
I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
SIGNATURE OF EVALUATOR
TITLE OF EVALUATOR
DATE
ATTACHMENT 6
RFP: HSCESS-10-R-00001
PAST PERFORMANCE QUESTIONNAIRE
PAGE
ATTACHMENT 6
RFP: HSCESS-10-R-00001
PAST PERFORMANCE QUESTIONNAIRE
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