Attachment_C_Past_Performance_Questionnaire.pdf

ATTACHMENT C

PAST PERFORMANCE QUESTIONNAIRE

PLEASE EMAIL THIS PACKAGE TO: LASHAWN SMITH, CONTRACTING OFFICER AT

lashawn.smith@fema.dhs.gov and Isaac.Chapple@fema.dhs.gov, BY TBD at 10:00 am EST

MUST INCLUDE IN EMAIL SUBJECT LINE:

PAST PERFORMANCE, RFP Number HSFE70-17-R-0012

INDIVIDUAL ASSISTANCE SUPPORT CONTRACT (IASC)

NAME OF CONTRACTOR

The Federal Emergency Management Agency recently released a solicitation for a contractor to provide support services for Mass Care Support Services. Offerors were asked to provide information on contracts, similar in size and complexity to the procurement, on which they had performed in the past. An Offeror has submitted you as a reference for past performance.

We need your opinion on how well the Contractor performed on this contract (Complete blocks 1 & 2 below). Please fill out the attached questionnaire and forward to the above mentioned individuals. 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, LaShawn Smith, by email at lashawn.smith@fema.dhs.gov and copy Isaac Chapple and Amanda Morgan.

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 PLEASE ENTER NAME OF CONTRACTOR Block 2. Contract Name/Identifier PLEASE ENTER CONTRACT 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/Role (e.g. Program Manager, Contracting Officer)

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

Evaluator’s Signature Date Phone Fax

INSTRUCTIONS

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

Rating Scale is located on the last page of this document mailto:lashawn.smith@fema.dhs.gov mailto:Isaac.Chapple@fema.dhs.gov mailto:lashawn.smith@fema.dhs.gov

Please mark the column to the right of each element that most appropriately reflects your experience with this contractor. Please use the additional page to discuss more fully any of the elements. Whenever you mark “Other”, please provide comments.

Performance Element Outstanding Satisfactory Unsatisfactory Other/Comments

1. QUALITY OF SOLUTION: The contractor comprehended the goals, thoroughly analyzed the task, and presented a comprehensive, complete, feasible, and effective solution. (Met the needs and performed successfully).

2. EFFECTIVE AND EFFICIENT USE OF

RESOURCES: The Contractor assigned, in a timely manner, the proper amount and type of personnel, facilities, and other resources to support 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

ATTENTIVENESS: 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.

For #8 and #9 please answer "Yes" or "No" as appropriate YES NO

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

9. 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. Please add additional pages as necessary.

Performance Element #1, Quality of Solution:

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:

Question #8, Given the choice would you do business with this contractor again?

Question #9, Did either you or the contractor have to resort to litigation to resolve problems?

Additional Comments.

RATING SCALE: Please use the following ratings to answer the questions on page 3.

Rating Definition

Outstanding Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual perfo of the element or sub-element being assessed was accomplished with few minor problems for which co actions taken by the contractor were highly effective.

Very Good

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual perfo of the element or sub-element being assessed was accomplished with some minor problems for corrective actions taken by the contractor were effective.

Acceptable Performance meets contractual requirements. The contractual performance of the element or sub-element contain minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-e being assessed reflects a serious problem for which the contractor has not yet identified corrective action contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unacceptable

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The con performance of the element or sub-element contains serious problem(s) for which the contractor’s co actions appear or were ineffective.

Neutral No record exists.

NOTE: For statements indicating less than “Acceptable”, please provide a brief explanation in the comments section of the survey