Attachment_3_-_Past_Performance_Questionnaire.pdf

Attachment 3 - Past Performance Questionnaire

Solicitation: HSFE06-17-R-0003

DR-4277-LA

DHS/FEMA Page 1 of 7 Nov 2016

(Offeror to complete Part I prior to providing this questionnaire to the Evaluator.)

In order to assess potential vendors under the above-referenced solicitation HSFE06-17-R-0003, 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 manufactured housing units in several parishes within in the state of

Louisiana that were affected by the Louisiana Floods. 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. This completed

Past Performance Questionnaire shall be returned to the offerer by the due date established by the offeror.

RETURN THIS QUESTIONNAIRE VIA EMAIL TO

sharon.edwards3@fema.dhs.gov

<insert your company name above>

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 Edwards at the e-mail address indicated above.

PART I – TO BE COMPLETED BY OFFEROR AND TRANSMITTED TO CLIENT

FOR COMPLETION.

A. CONTRACT INFORMATION:

NAME OF

CONTRACTOR/OFFEROR:

1 Agency Name/Location:

2 Program/Project Title:

Type of Instrument (e.g.

Contract/Order/Subcontract/Other):

4 Contract Identification Number:

5 Order Number (If applicable):

DR-4277-LA

DHS/FEMA Page 2 of 7 Nov 2016

6 Project Service Description (Add attachment if necessary):

Type of Contract (e.g.

Negotiated, Sealed Bid):

Pricing Type (e.g. fixed price, cost reimbursement, other):

9 Competitive (Y/N):

Follow-on Work Available

(Y/N):

Follow-on Work Awarded to

Offeror (Y/N):

11 Date of Award:

Initial Contract Dollar Value

(w/Options):

Final Contract Dollar Value

(w/Options):

14 Period of Performance:

15 Place(s) of Performance:

Complexity of Work (e.g.

difficult, routine, simple):

16 Type and extent of subcontracting (add rows if needed):

DHS/FEMA Page 3 of 7 Nov 2016

PART II – TO BE COMPLETED BY OFFEROR’S CLIENT AND E-MAILED TO

CONTRACTING OFFICER

A. REFERENCE RESPONDENT INFORMATION

1 Name (please print):

2 Agency / Company:

3 Position Title:

4 Phone Number (include area code):

5 Fax Number (include area code):

6 Email Address:

7 Mailing Address:

8 Your Role Relative to the Project/

Contract (e.g., COTR, PM):

9 Length of Involvement in

Project/Contract:

10 Questionnaire Completion Date:

DHS/FEMA Page 4 of 7 Nov 2016

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.

Rating Symbol Definition

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.

DHS/FEMA Page 5 of 7 Nov 2016

C. PAST PERFORMANCE

Rating Scale:

O - Outstanding G - Good A - Acceptable U - Unsatisfactory N - Neutral

Quality O G A U N

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:

Cost Control O G A U N

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

Timeliness O G A U N

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

DHS/FEMA Page 6 of 7 Nov 2016

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

Management O G A U N

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

DHS/FEMA Page 7 of 7 Nov 2016

Thank your for your assistance in supporting this source selection activity.