The file's text, extracted by GovTribe without its formatting.
HSFE02-12-R-4110
PAST PERFORMANCE QUESTIONNAIRE
Attachment 5
PAST PERFORMANCE QUESTIONNAIRE
(Offeror to complete Part I prior to providing this questionnaire to the Evaluator.)
In order to assess potential vendors under the above-referenced solicitation HSFE02-12-R-4110, the DHS/FEMA contracting office is obtaining past performance information with respect to each offeror. The contract resulting from this procurement will provide DHS/FEMA with support for maintenance and deactivation of temporary housing units in the state of New York counties affected by Hurricane Irene and Tropical Storm Lee. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. This is a critical acquisition being conducted by DHS/FEMA and your support is sincerely appreciated. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire. The completed Past Performance Questionnaire shall be submitted directly via email from the customer referenced by the due date established for receipt of questionnaires. The message must originate from the Evaluator’s corporate or government email system. The “subject” line in the submission email shall clearly indicate: HSFE02-12-R-4110, Submission for Offeror <insert name of Offeror>.
Please send an email with the Past Questionnaire as an attachment to:
Sharon.leroux@fema.dhs.gov
DO NOT RETURN THIS QUESTIONNAIRE TO THE OFFEROR
If you need more space than that provided, attach additional pages. Responses will be treated as source selection sensitive information. If you have any questions, please contact Sharon LeRoux at the e-mail address indicated above.
PART I – TO BE COMPLETED BY OFFEROR AND TRANSMITTED TO CLIENT FOR COMPLETION.
A.
CONTRACT INFORMATION:
| 3 |
| Type of Instrument (e.g. Contract/Order/Subcontract/Other): |
| 4 |
| Contract Identification Number: |
| 5 |
| Order Number (If applicable): |
| 6 |
| Project Service Description (Add rows if needed): |
| 7 |
| Type of Contract (e.g. Negotiated, Sealed Bid): |
| 8 |
| Pricing Type (e.g. fixed price, cost reimbursement, other): |
| 10 |
| Follow-on Work Available (Y/N): |
Follow-on Work Awarded to Offeror (Y/N):
| 12 |
| Initial Contract Dollar Value (w/Options): |
| 13 |
| Final Contract Dollar Value (w/Options): |
| 14 |
| Period of Performance: |
| 15 |
| Place(s) of Performance: |
| 15 |
| Complexity of Work (e.g. difficult, routine, simple): |
| 16 |
| Type and extent of subcontracting (add rows if needed): |
PART II – TO BE COMPLETED BY OFFEROR’S CLIENT
A.
Reference Respondent Information
| 4 |
| Phone Number (include area code): |
| 5 |
| Fax Number (include area code): |
| 8 |
| Your Role Relative to the Project/ Contract (e.g., COTR, PM): |
| 9 |
| Length of Involvement in Project/Contract: |
| 10 |
| Questionnaire Completion Date: |
B.
Performance Assessment Please rate the contractor’s performance on the identified program using the following rating scale. Assessments should reflect only contract performance for which the contractor is responsible.
| Outstanding |
| O |
| Based on the Offeror’s record of past performance, no issues, concerns, or risks are associated with receiving timely services and contract performance. Past performance surveys and the Offeror’s experiences indicate that the Offeror is capable of significantly exceeding the requirements of the RFP. |
| Good |
| G |
| The Offeror’s record of past performance indicates there is very little risk associated with receiving quality products, timely services and full contract performance. Past performance surveys and the Offeror’s experience indicate the Offeror is capable of exceeding the requirements of the RFP. |
| Acceptable |
| A |
| The Offer’s record of past performance indicates that there is some potential risk associated with receiving quality products, timely services, and contract performance. Past performance surveys and the Offeror’s experience indicate the Offeror is capable of meeting the requirements of the RFP. |
| Unsatisfactory |
| U |
| The Offeror’s record of past performance indicates it is likely to have problems meeting the requirements of the RFP. |
| Neutral |
| N |
| No past performance/experience available for evaluation. Offeror has asserted that it has no directly related or relevant past performance experience. Proposal receives no merit or demerit for this factor. |
C.
Past Performance Rating Scale:
O - Outstanding G - Good A - Acceptable U - Unsatisfactory N - Neutral
| 1 |
| Overall quality of the project |
| 2 |
| Qualifications and quality of key personnel to meet the objectives of the project |
| 3 |
| Procedures that ensured the level of quality remained constant throughout the life of the project. |
| 4 |
| Adequacy, relevance and reasonableness of the quality management approach, procedures, documentation and methods |
| 5 |
| Quality of products, materials and services for the price paid |
| 6 |
| Accuracy of the record keeping procedure and ability to prepare accurate and timely reports |
| 7 |
| Ability to implement effective corrective actions and improvements |
Comments:
| 8 |
| Demonstrated a process for management of the program costs and segmentation of costs for improved manageability |
| 9 |
| Demonstrated financial stability during the project performance period |
| 10 |
| Demonstrated effectiveness in reducing project costs from the baseline cost estimates |
| 11 |
| Demonstrated reasonableness of proposed modification costs |
| 12 |
| Demonstrated reasonableness in labor and O&M costs |
| 13 |
| Timeliness in completing the overall project. |
| 14 |
| Completion of tasks in accordance with project schedule’s critical milestone dates |
| 15 |
| Timeliness in completing reports |
| 16 |
| Timeliness of responses to client requests and inquiries |
Rating Scale:
O - Outstanding G - Good A - Acceptable U - Unsatisfactory N - Neutral
| Business Relations |
| O |
| G |
| A |
| U |
| N |
| 17 |
| Demonstrated a business-like concern for your agency’s / company’s interests |
| 18 |
| Relationship with client technical and functional personnel |
| 19 |
| Relationship with contracting office personnel |
| 20 |
| Relationship with subcontractors |
| 21 |
| Cooperation and innovation in problem solving |
| 22 |
| Compliance with the terms of the contract |
| 23 |
| Utilized effective program and project management processes, tools, and reporting |
| 24 |
| Had satisfactory and complete management plan |
| 25 |
| Demonstrated effectiveness in use of risk management to proactively reduce project disruptions |
| 26 |
| Ability to retain key personnel |
| 27 |
| Availability and accessibility of key personnel |
| 28 |
| Flexible in responding to changing needs |
| 29 |
| Adequate processes and metrics for the evaluation of their own overall management performance |
| 30 |
| Adequate subcontractor management procedures |
| 31 |
| Demonstrated effectiveness in risk identification, escalation, response and monitoring procedures |
| 32 |
| Demonstrated effectiveness in capturing incidents and resolving problems |
| 33 |
| Ability to provide a product or service that met your mission requirements |
Based on this Contractor’s overall performance, would you award them another contract? Why or why not? Did the provided solution from this contractor work and how well did it work?
D.
Additional Remarks Thank your for your assistance in supporting this source selection activity.
DHS/FEMA
December 19, 2011
<INSERT OFFEROR NAME>
