MHU_PPQ_Form_12-18.docx

Attachment #14 Page 1 of 4

PAST PERFORMANCE QUESTIONNAIRE

The Department of Homeland Security (DHS), FEMA, recently released a Request for proposal for the procurement of Manufactured Housing Units (MHUs)RFP #HSFE70-14-R-0005. Offerors were asked to provide information on contracts similar in nature, size and complexity to the present requirement on which they had performed in the past. An offeror has submitted you as a reference for past performance. (See blocks 1 to 3 below).

We need your opinion on how well the contractor performed on this contract. Please fill out the attached questionnaire and return it to the offeror in an envelope which is both taped and signed across the seal. The offeror will include this envelope as an enclosure to its Volume I – Past Performance submission. DHS/FEMA may contact you to clarify or verify any information provided.

Your input will be confidential. Please note your comments will be used to form the basis for evaluation of this offeror. Thank you in advance for your assistance. If you have any questions please contact Zahra Hashmi, Contracting Officer at (202)2646-7072 by email at zahra.hashmi@fema.dhs.gov.

CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Block 1. Contractor Name:

Block 2. Contractor phone number and address:

Block 3. Contract Name and Number: | I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Evaluator’s Printed Name Title

Evaluator’s Mailing Address (Agency, Bldg/Room, Street, City, State, Zip)

INSTRUCTIONS

Two forms are provided to document your opinion: 1) Performance Rating Form; and 2) Supplemental Comment Form. Please fill out both forms in accordance with the instructions provided on each. Please use the following standards in arriving at your rating:

Satisfactory - Contractor, met customer expectations and requirement Unsatisfactory – Contractor, was either marginal or did not meet customer expectations and requirements Other - The element is not applicable, no data has been obtained, or additional comments are provided

1. QUALITY OF SERVICES: The contractor provided high quality of service and performed successfully.

2. EFFECTIVE AND EFFICIENT USE OF RESOURCES: The contractor used an efficient number of resources e.g. personnel, facilities and other resources to support the project. Use of subcontractors was appropriate in supporting the project.

3. COMMUNICATION: The contractor worked and communicated well with client management, staff, and contracting officials as well as with his or her own staff and subcontractors.

4. TIMELINESS OF PERFORMANCE: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time.

5. CUSTOMER SATISFACTION: The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.

6. RESPONSIVENESS AND ATTENTIVESNESS: The contractor exhibited reasonable and cooperative behavior in response to client changes, criticism/rejection of contract deliverables and in detecting and correcting errors, poor performance, and other problems.

7. COST CONTROL: The contractor successfully planned and proposed realistic costs and monitored performance, and consistently operated at or below budget.

8. SUBCONTRACTING PLAN: The contractor put forth good faith effort in meeting it small and disadvantaged business goals.

9. TECHNICAL PROFICIENCY: The contractor demonstrated the highest level of technical proficiency required for completion of the task in a timely and successful manner.

10. RISK MANAGEMENT: The contractor was proactive and was able to overcome and mitigate any contract obstacles that surfaced.

11. Given the choice would you do business with this contractor again?

12. Did either you or the contractor have to resort to litigation to resolve problems?

Supplemental Comment Form

Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. We appreciate your time and valuable comments. Please add additional pages as necessary.

Performance Element #1, Quality of Services:

Performance Element #2, Effective and Efficient Use of Resources:

Performance Element #3, Communication:

Performance Element #4, Timeliness of Performance:

Performance Element #5, Customer Satisfaction:

Performance Element #6, Responsiveness and Attentiveness:

Performance Element #7, Cost Control:

Performance Element #8, Subcontracting Plan:

Performance Element #9, Technical Proficiency:

Performance Element #10, Risk Management:

Question #11, Given the choice would you do business with this contractor again?:

Question #12, Did either you or the contractor have to resort to litigation to resolve problems?:

Additional Comments: