Attachment_J005_-_Past_Performance_Questionnaire.pdf

Past Performance Questionnaire

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number: HSFE80-17-R-0004

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, entitled Administrative Management and General Consulting Services. 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 2:00 p.m. (ES) on 1 June 2017. Your questionnaire may be submitted electronically to the Contracting Officer at (fema-pa-taciv@fema.dhs.gov).

Your cooperation is greatly appreciated. Questions may be directed to the undersigned at fema-pa-taciv@fema.dhs.gov.

Sincerely, // signed //

Daisy Joseph Contracting Officer

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: __________________________ Contract No.:____________________________

Contract Title: _________________________________

POC: _______________________________ Title: _________________________________

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

The following questions pertain to the contractor’s record of past (within the past five 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 Agency is requesting that you use following adjectival ratings shall be used in your response:

Outstanding: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

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

Outstanding (explanation must be provided in comments field below)

Good

Acceptable

Marginal (explanation must be provided in comments field below)

Unsatisfactory (explanation must be provided in comments field below) Comments:

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

Acceptable

Marginal (explanation must be provided in comments field below)

C. TIMELINESS OF PERFORMANCE FOR SERVICES AND PRODUCT

DELIVERABLES

Acceptable

Marginal (explanation must be provided in comments field below)

D. COMMITMENT TO CUSTOMER SATISFACTION AND BUSINESS-LIKE

CONCERN FOR ITS CUSTOMERS’ INTEREST

Acceptable

Marginal (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. (ES) on 1 June 2017 also identified in the cover letter (fema-pa-taciv@fema.dhs.gov).

//signed//

Daisy Joseph