DRAFT_Attachment_J.4_Past_Performance_Questionnaire.docx

Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA) Operations and Maintenance (O&M) Past Performance Questionnaire

HSFE30-16-R-0009

Date:

To:

Dear "Client":

The Federal Emergency Management Agency (FEMA) for the Office of Chief Information Officer is interested in your assessment of [enter your company name] performance on your contract for the purpose of utilizing this information to evaluate the firm’s probability of successfully performing a federal government requirement that is currently being advertised.

FEMA is placing increased emphasis in its procurements on past performance as an evaluation factor. FEMA is requiring that past or current clients of companies responding to its RFP be identified and their participation in the evaluation process be requested. In this regard, we have identified Mr./Ms.____________ of your organization as the point of contact based on his/her knowledge concerning their work. We, therefore, request that you complete the attached Past Performance Questionnaire Form and email the required response as an attachment to the FEMA Contracting Officer at Nicole.Smith@dhs.fema.gov and Edna.McKellery@dhs.fema.gov.

Questionnaires must be received by the FEMA Contracting Officer by XXXXX Eastern Standard Time on XXXX. If you have questions regarding the attached questionnaire, or require assistance, please contact the FEMA Contracting Officer.

Thank you for your assistance.

Signature and Title

PAST PERFORMANCE QUESTIONNAIRE FORM

SECTION 1: OFFEROR INFORMATION (to be completed by the Offeror requesting evaluation prior to sending to Client)

A. Offeror’s name and address:

B. Point of Contact:

C. Phone Number:

D. Contract Number:

E. Project Title or Description of Work performed under this project:

F. Problems Encounter and Corrective Action

G. Contract Type: |_| Firm Fixed Price |_| Indefinite Delivery/Indefinite Quantity Task Order |_| Cost Reimbursement |_| Time & Material |_| Labor Hour |_| Incentive

I. Project Award Amount: Current/Final Project Amount:

J. Contractor being evaluated performed as the |_| Prime Contractor |_| Subcontractor |_| Supplier

K. Authorization is hereby granted to provide the information requested in this Questionnaire.

(Signature)

(Name and Title of Authorized Official) (Date)

SECTION 2: RESPONDENT INFORMATION (to be completed by respondent)

EVALUATED BY:

(Signature) (Date)

(Typed or Printed Name)

(Title)

(Phone Number)

(Address)

SECTION 3: PERFORMANCE INFORMATION: Choose the rating that most accurately describes the Contractor’s performance or situation. Please provide a narrative explanation for any ratings of poor or unacceptable.

Note: When assigning a rating to the questions below, place an X in the box under your rating selection.

Question 1. Performance What is your assessment of the Contractor’s ability to meet your requirements?

Comments, if any

Questions 2. Timeliness What is your assessment of the Contractor’s ability to meet established IT Operations and Maintenance schedules?

Question 3. Overall Rating of Contractor’s performance What is your overall rating of Contractor’s performance (requirements, schedule, and price) on contract being assessed?

Question 4. Responsiveness What is your assessment of the Contractor’s ability to identify issues and cooperate to resolve problems, attended meetings as needed and maintained communication with the government to maintain operational status and minimize downtime?

Question 5. Staffing What is your assessment of the Contractors ability to provide qualified staff with extensive technical knowledge?

Additional Comments: