Attachment_3_-_Past_Performance_Questionnaire_-_HSFE07-13-Q-0006.docx

Attachment E.3 - Past Performance Questionnaire Solicitation: HSFE07-13-Q-0006

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

In order to assess potential vendors under the above-referenced solicitation HSFE07-13-Q-0006, 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 security guards at the Joint Field Office and/or Disaster Recovery Centers of Iowa affected by the disaster. 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 by the due date established within this solicitation.

If you have any questions, please contact Stewart Knotts at stewart.knotts@fema.dhs.gov

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

FOR COMPLETION.

A. CONTRACT INFORMATION:

NAME OF CONTRACTOR/OFFEROR:

Agency Name/Location:

Program/Project Title:

Type of Instrument (e.g. Contract/Order/Subcontract/Other):

Contract Identification Number:

Order Number (If applicable):

Type of Contract (e.g.

Negotiated, Sealed Bid):

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

Competitive (Y/N):

Follow-on Work Available (Y/N):

Offeror (Y/N):

Date of Award:

Initial Contract Dollar Value (w/Options):

Final Contract Dollar Value (w/Options):

Period of Performance:

Place(s) of Performance:

Attachment 3 - Past Performance Questionnaire

PART II – TO BE COMPLETED BY OFFEROR’S CLIENT AND E-MAILED TO CONTRACTING OFFICE – stewart.knotts@fema.dhs.gov

A. REFERENCE RESPONDENT INFORMATION

code):

Project/Contract:

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.

Quality

G

A

U

N

meet the objectives of the project

quality management approach, procedures, documentation and methods

the price paid

actions and improvements

Comments:

Cost Control

G

A

U

N

project performance period

costs from the baseline cost estimates

modification costs

Timeliness

G

A

U

N

schedule’s critical milestone dates

inquiries

Attachment 3 - Past Performance Questionnaire

C.

PAST PERFORMANCE

Rating Scale:

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

Business Relations

G

A

U

N

agency’s / company’s interests

Management

G

A

U

N

management processes, tools, and reporting

management to proactively reduce project disruptions

evaluation of their own overall management performance

procedures

incidents and resolving problems

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