Past_Performance_Questionnaire.pdf

Attachment B

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number: HSFE80-15-R-0007

Dear Sir/Ma’am;

The Department of Homeland Security is currently conducting a competitive source selection to evaluate offerors on subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state or local government or commercial contracts as compared to North American Industry Classification System (NAICS) 541611. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation. Please complete the enclosure and return to the Contracting Officer shown below, no later than 5 days after receipt of request or 2:00 p.m. (EST) on 17 July 2015, whichever occurs first. Your questionnaire may be submitted electronically to the Contracting Officer at Daisy.Joseph@fema.dhs.gov.

Your cooperation is greatly appreciated. Questions may be directed to the undersigned at Daisy.Joseph@fema.dhs.gov.

Sincerely, // signed //

Daisy Joseph Contracting Officer

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: __________________________ Contract No.:____________________________

Subcontract No. (if applicable): _________________________________

POC: _______________________________ Title: _________________________________

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

a. Superior. Based on an offeror’s past performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

b. Satisfactory. Based on an offeror’s past performance record, some doubt exists that the offeror will successfully perform the required effort.

c. Unsatisfactory. Based on an offeror’s past performance record, extreme doubt exists that the offeror will successfully perform the required effort.

d. Neutral rating. No relevant pefromance record is identifiable upon which to base a meaningful performance rating. A search was unable to identify any relevant past performance information for the offeror or key team members/subcontractors or their key personnel. This is neither a negative or positive assessment.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number/Identification Number:

Contract Type:

Prime Contractor Name (if different from contractor sited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of Contractual Effort / Items Purchased:

B. INDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

A. COMPLIANCE OF PRODUCTS, SERVICES, DOCUMENTS, AND RELATED

DELIVERABLES TO SPECIFICATION REQUIREMENTS AND STANDARDS

OF GOOD WORKMANSHIP

Superior (explanation must be provided in comments field below)

Satisfactory

Unsatisfactory (explanation must be provided in comments field below)

Neutral Rating

Comments:

B. EFFECTIVENESS OF PROJECT MANAGEMENT (to include use and control of subcontractors)

Unsatisfactory (explanation must be provided in comments field below)

C. TIMELINESS OF PERFORMANCE FOR SERVICES AND PRODUCT

DELIVERABLES

Unsatisfactory (explanation must be provided in comments field below)

D. COMMITMENT TO CUSTOMER SATISFACTION AND BUSINESS-LIKE

CONCERN FOR ITS CUSTOMERS’ INTEREST

Unsatisfactory (explanation must be provided in comments field below)

E. GENERAL COMMENTS. PROVIDE ANY OTHER RELEVANT

PERFORMANCE INFORMATION

F. OTHER INFORMATION SOURCES. PLEASE PROVIDE THE FOLLOWING

INFORMAITON:

Are you aware of other relevant past efforts by this company? (if yes, please provide the name and telephone number of a point of contact).

G. RESPONDENT IDENTIFICATION. PLEASE PROVIDE THE FOLLOWING

INFORMATION:

Organization:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART III. RETURN INFORMAITON

Please return this completed Questionnaire via e-mail to the Contracting Officer not later than 2:00 p.m. (EST) on 17 July 2015, also identified in the cover letter (daisy.joseph@fema.dhs.gov).

//signed//

Daisy Joseph