Past Performance Questionnaire.docx

Part II: Past Performance Questionnaire Contact [to be completed by Agency or Organization Receiving Services]

Instructions: The following questionnaire will be considered in a Health and Human Services competitive acquisition being conducted among 8 (a) Offerors. The Offeror who provided this questionnaire to you wishes to have your responses considered as part of the HHS’s past performance evaluation in the acquisition. Please complete the questionnaire and provide an electronic copy before the time set for receipt of proposals in accordance with Part I. .

Answers to Questions 1-3 are for general information and are needed to place the remaining questionnaire answers in context. For questions 4- 15 please provide a narrative response and a rating. Detailed narrative responses serve as the most important guide to future performance. Therefore, HHS regards your narrative responses as the most important aspect of this questionnaire and would deeply appreciate your time in preparing those responses. Please also rate the Contractor on a scale of 1-10, where one (1) represents a completely unsatisfactory experience and ten (10) an outstanding experience, with the Contractor with respect to the subject of the question. We would especially appreciate narrative elaboration for ratings that are very low (1-3) or very high (8-10). If you have no experience with the Contractor on the identified contract with respect to the question, select N/A.

1. Please identify the individual completing this questionnaire.

Name:

Title:

Present Employer:

Telephone Number:

E-Mail Address:

2. What was your relationship to, and role with respect to, the contract identified in Part I above?

3. Is the contract accurately described?

4. What were you experiences with the quality of the services provided by this Contractor?

Bold or Underline a Rating: 1 2 3 4 5 6 7 8 9 10 N/A

5. What were your experiences with the Contractor’s adherence to contract schedules?

6. What were you experiences with the Contractor’s overall ability to meet schedules for delivery of reports.

7. What were you experiences with the Contractor’s ability to meet any special requirements for expedited delivery or service?

8. What were your experiences with the Contractor’s conforming to contract requirements generally?

9. What were your experiences with the Contractor’s standards of professionalism?

10. What were your experiences with the Contractor’s controlling costs and working with you to limit additional costs and, if you are a Government agency, to limit upward equitable adjustments to the Government’s price in the event of changes?

11. What were your experiences with the Contractor’s integrity and business ethics?

12. What were your experiences with the Contractor’s spirit of cooperation and fairness of business dealing with you?

13. What were your experiences with the Contractor’s commitment to your satisfaction as a customer and concern for your business interests?

14. What were your experiences with the Contractor’s reporting into Government databases to which it was obliged to report?