ATTACHMENT_5__PAST_PERFORMANCE_QUESTIONNAIRE__HSFE70-16-R-0005_8.5.16.docx

Attachment 5– HSFE70-16-R-0005

PAST PERFORMANCE QUESTIONNAIRE

The Department of Homeland Security (DHS), FEMA, recently released a Request for Proposal for the procurement of supplies or services for RFP #HSFE70-16-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 this to you as a reference for past performance. (See blocks 1 to 3 below).

We need your opinion on how well the contractor performed on your contract(s). Please fill out the attached questionnaire and send it electronically to both the Contracting Officer, at: Carolyn.Knight@fema.dhs.gov. To be considered, this form must be filled out and received by the contracting officer no later than the closing date and time listed in the request for proposal. DHS/FEMA may contact you to clarify or verify any information provided. For purposes of confidentiality, only send this completed form to both the FEMA contracting officer and contract specialist.

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 Ms. Carolyn Knight, Contracting Officer, via email at: Carolyn.Knight@fema.dhs.gov.

A. 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)

B. INSTRUCTIONS

Please complete this past performance questionnaire in accordance with the ratings provided herein. Please use the following ratings in arriving at your final evaluation: 1) Superior – the contractor undoubtedly performed successfully in every aspect of the effort 2) Satisfactory – the contractor’s overall performance was successful but with some minor exceptions 3) Unsatisfactory – the contractor’s overall performance was unsatisfactory or 4) Neutral.

Sub-Factor 1: Relevancy

At a minimum, evaluators shall address the following two aspects to the past performance evaluation, tied directly to the work performance being evaluated:

1) The first aspect of the past performance evaluation is for the evaluator to evaluate whether the offeror’s present/past performance is relevant or not relevant to the effort to be acquired. Relevant is defined as work similar in complexity and magnitude to the work identified in this solicitation.

2) The second aspect of the past performance evaluation is to determine how well the contractor performed on the contracts.

Sub-Factor 2: Customer Satisfaction

With respect to customer satisfaction, evaluators shall provide a rating for customer service. Customer service specifically relates to the vendor’s past performance on contracts with government agencies and private industry.

Evaluators shall provide a rating for customer satisfaction, directly related to their knowledge of the offeror’s performance, in terms of project management, accuracy of cost estimates, cost control, quality of work, completion of projects within budget, and compliance with performance schedules for contracts of a similar type, size and scope.

This specific Past Performance Questionaire (PPQ) shall be for contractual work which was similar to the requirements set forth herein this solicitation.

PPQs shall be for projects completed within the last five (5) years, or projects which are currently in progress.

Contracts with the parent or an affiliate of the offeror may not be used.

Sub-factor 3: Timeliness of performance and the completion of the contract

With respect to timeliness of performance and the completion of the contract, evaluators shall provide a list of any contracts, whereby the offeror was terminated for convenience and/or terminated for default within the last three (3) years.

Evaluators shall also list any contracts for which the vendor did not receive an exercise of an option to continue the contract within the last three (3) years, and shall include an explanation as to why the option was not exercised.

Notice to evaluators: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available, the offeror will not be given a favorable or unfavorable evaluation rating. The offeror will receive a neutral rating for the past performance factor.

The Government also reserves the right to also use Contractor Performance Assessment Reports (CPARS) from the Past Performance Information Retrieval System (PPIRS) in the past performance evaluation of an organization.

The government will rate the offeror’s proposal using 1 of 4 evaluation ratings:

OVERALL PERFORMANCE RATING FORM (put an X in the appropriate box)

OVERALL PERFORMANCE: Please place a checkmark in the appropriate box.

Sub-Factor 1: Relevancy

Sub-Factor 2: Customer Satisfaction

Sub-factor 3: Timeliness of performance and the completion of the contract

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

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

1) Superior – the contractor undoubtedly performed successfully in every aspect of the effort

2) Satisfactory – the contractor’s overall performance was successful but with some minor exceptions

3) Unsatisfactory – the contractor’s overall performance was unsatisfactory, or

4) Neutral.