J.12 Past Performance Information Form Template.pdf

J.12 – CONTRACTOR PAST PERFORMANCE INFORMATION

List three (3) to five (5) of the most recent and relevant contracts/agreements for efforts similar to the work in the subject proposal. The most relevant indicators of performance are contracts of similar size, technical scope, and complexity to the Statement of Work and how recently they were performed. In this case, scope refers to the global procurement and delivery of goods (not necessarily health commodities).

PART I: Contractor/Award Information

1. Contractor:

2. Information Provided in Response to RFP No.:

3. Name of Awarding Entity:

4. Contract/Award Number:

5. Contract/Award Type:

6. Contract/Award Period of Performance:

7. Contract/Award Value (TEC/TEA): (if subcontract/subaward, subcontract/subaward value)

8. Overall Description of the Award (details that describe the breadth and volume of related transactions; scope of work or complexity/diversity of tasks; and Primary location(s) of work):

9. Relevance to the RFP:

10. If extraordinary problems impacted the contract/award, provide a short explanation and the corrective action taken:

11. Describe any quality awards or certifications that indicate exceptional capacity to provide the service or product described in the statement of work:

Contracts/Awards Contact Information: (Name, Telephone Number and Email address)

12a. Contracting/Agreement/Awarding Officer:

12b. Contracting Officer’s Representative (COR)/Agreement Officer’s Representative:

(AOR)/Project Manager:

12c. Other:

PART II: Performance Assessment (to be completed by Awarding Entity)

13. Quality of product or service, including consistency in meeting goals and targets, and cooperation and effectiveness of the Prime in fixing problems.

Comment:

14. Cost control, including forecasting as well as accuracy in financial reporting.

Comment:

15. Customer satisfaction, including satisfactory business relationship to clients, initiation and management of several complex activities simultaneously, coordination among Sub-contractors and developing country partners, prompt and satisfactory correction of problems, and cooperative attitude in fixing problems.

Comment:

16. Regulatory Compliance including compliance with all terms and conditions in the contract/order relating to applicable regulations and codes.

Comment:

17. Utilization of Small Business including: efforts in achieving small business participation goals.

Comment: