ATTACH C_PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 20 KB Posted
- Attached to
- Personal Assistance Services - Home Health Aides
- Solicitation number
- HSFEHQ-12-R-0001
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PAST PERFORMANCE QUESTIONNAIRE
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Other files
| File | Type | Posted |
|---|---|---|
| PAS Q A2.pdf | ||
| PAS Q A.pdf | ||
| ATTACH C_PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| ATTACH D_Full Text FAR Clauses and Provisions.pdf | ||
| ATTACH A_PAS Statement of Work.pdf | ||
| ATTACH B_PRICE COST SCHEDULE.xlsx | XLSX spreadsheet | |
| ATTACH D_Full Text FAR Clauses and Provisions.docx | DOCX document | |
| ATTACH A_PAS Statement of Work.docx | DOCX document | |
| ATTACH B_PRICE COST SCHEDULE.xlsx | XLSX spreadsheet |
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RFP No. HSFEHQ-12-R-0001 ATTACHMENT C
PAST PERFORMANCE QUESTIONNAIRE
PLEASE EMAIL THIS PACKAGE TO: Michelle Calhoun, CONTRACTING OFFICER AT michelle.calhoun@fema.dhs.gov by 12:00 PM on the date of 03/05/2012
MUST INCLUDE IN EMAIL SUBJECT LINE:
PAST PERFORMANCE, RFP Number HSFEHQ-12-R-0001
PERSONAL ASSISTANCE SERVICES (PAS)
NAME OF CONTRACTOR
The Federal Emergency Management Agency recently released a solicitation for a Contractor(s) to provide support services for a Personal Assistance Services (PAS) Contract. 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 send it to Michelle Calhoun. FEMA may contact you to clarify and/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 Michelle Calhoun by email at Michelle.Calhoun@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 | 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/Room, 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:
Outstanding – Contractor exceeded client expectations and requirements Satisfactory – Contractor met customer expectations and requirements 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
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. TIMELINESS OF PERFORMANCE: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time. The Contractor assigned, in a timely manner, the proper amount and type of personnel to successfully accomplish the specified effort.
2. CUSTOMER SATISFACTION: The contractor exhibited a commitment to customer satisfaction by providing a high level of quality of care and by consistently exhibiting a professional approach to client service.
3. RESPONSIVENESS AND ATTENTIVENESS: The contractor exhibited reasonable and cooperative behavior in quickly remedying any performance related issues with the client.
4. COST CONTROL: The contractor successfully planned and proposed realistic costs and monitored performance, and consistently operated at or below budget, such as travel related expenses.
For #5 and #6 please answer "Yes" or "No" as appropriate
| YES |
| NO |
5. Given the choice would you do business with this contractor again?
6. 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 - Timeliness of Performance:
Performance Element #2 - Customer Satisfaction:
Performance Element #3 - Responsiveness and Attentiveness:
Performance Element #4 - Cost Control:
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?
Additional Comments:
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