J.9-Past Performance Questionnaire.docx
DOCX document 31 KB Posted
- Attached to
- Workers' Compensation Review Contractor (WCRC) Federal contract opportunity
- Solicitation number
- 75FCMC23R0010
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions and Answers.xlsx | XLSX spreadsheet | |
| J.8-Contractor Offeror Conflict of Interest.docx | DOCX document | |
| J.6 Appendix F - WCRC Cost Template.xlsx | XLSX spreadsheet | |
| J.7-Contractor-Business-Ethics-COI-and-Compliance-Program-Requirements Jan 2019.docx | DOCX document | |
| J.2 Appendix B - WCCCSUserGuide v6.3.pdf | ||
| J.3 Appendix C - WCRC Monthly Progress Report Example.pdf | ||
| J.5 Appendix E- WCMSA Ref Guide v3-6_031522.pdf | ||
| Solicitation RFP 75FCMC23R0010.pdf | ||
| J.1 Appendix A - Statement of Work 2022 (final).docx | DOCX document | |
| J.4 Appendix D - Q&A Template.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP-75FCMC23R0010
Attachment J-9 Past Performance Questionnaire
PAST PERFORMANCE QUESTIONNAIRE
CMS Solicitation No.75FCMC23R0010
(Company Being Evaluated) (Offeror)
| Offeror/Contractor: | ___________________________ | |
| Address: | ___________________________ | |
| ___________________________ |
Name of Contracting Activity:____________________________________________________ Brief Description of Work: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Contract Type:________________________________________________________________________ Total Contract Value:___________________________________________________________________ Performance Period:____________________________________________________________________ Please complete the following questionnaire about the Offeror/Contractor and indicate your responses in the blocks or columns, as appropriate. Numerical ratings are as indicated in the Rating Scale below. Other Ratings are as indicated in each block.
Rating Scale:
| N/A |
| Not Applicable: Question does not apply to the contract discussed in this report |
| 0 |
| Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
| 1 |
| Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| 2 |
| Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| 3 |
| Very Good: Performance meets contractual requirements and exceeds some to the Government/Business Entity’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective. |
| 4 |
| Exceptional: Performance meets contractual requirements and exceeds many to the Government/Business Entity’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective. |
We request that you justify each of your ratings with a comment. Please be as specific in your comment as possible, especially in situations that warrant very high or very low ratings. Use extra pages as necessary or expand the form electronically as needed.
CUSTOMER SERVICE
How did the contractor work collaboratively with the “customers” of the contract?
“Customers” may include, but are not limited to, other stakeholders (such as Medical Providers in a health insurance contract) critical to the success of the contract in question and those members of your staff responsible for the administration of the contract.
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
| Comments: |
| Rating: |
Is/was the contractor committed to customer satisfaction and would you hire this contractor again?
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
Comments:
FINANCIAL MANAGEMENT
Was the contractor timely and accurate in processing payments if the contractor administered funds and/or payments for services?
If the contractor administered funds and/or payments on this contract, was the contractor timely and accurate in submitting accounting reports?
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
| Comments: |
| Rating: |
OPERATIONAL EXCELLENCE
How was the contractor’s quality of products/services? How well did the contractor meet the standards and requirements of the contract’s Statement of Work? Was the contractor timely in meeting its contract schedule and/or requirements?
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
| Comments: |
| Rating: |
How well did the contractor utilize internal controls to effectively manage its staff and systems?
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
| Comments: |
| Rating: |
INNOVATIONS
How well did the contractor develop and continually refine its internal business processes to improve the quality of the work delivered on the contract?
If the contractor did incorporate internal business processes changes, what was the impact of those changes on the daily operations?
If there are any instances that are of particular note, either positive or negative, please give specifics around the citation.
| Comments: |
| Yes/No: |
Agency/Company COMPLETING Questionnaire
Agency/Company Name: ___________________________
Address: ___________________________
Signature of Individual Completing the Questionnaire: ____________________________________ Date
Name: ___________________________ Telephone No.: ________________________
Title: ___________________________ Email Address: ________________________
<OR>
Q1. Quality: Did the Offeror demonstrate the execution of quality efforts resulted in effective performance outcomes for work activities?
| Comments: |
| Rating: |
Q2. Cost Control: Did the Offeror demonstrate the ability to ensure costs were within budget?
| Comments: |
| Rating: |
Q3. Schedule: Did the Offeror demonstrate the ability to consistently meet project milestones and deliverables on time?
| Comments: |
| Rating: |
Q4. Management: Did the Offeror demonstrate a past track record of notifying its contractors/customers of problems, remaining flexible and reliable, and being responsive to contract requirements and recommending solutions? How well did the Offeror match the qualifications of the key position, as described in the contract, with the person that filled the key position? Did the Offeror support key personnel so they were able to work effectively?
| Comments: |
| Rating: |
Q4. Utilization of Small Business: Did the Offeror demonstrate and implement an effective and efficient small/small disadvantaged business subcontracting plan?
| Comments: |
| Rating: |
Agency/Company COMPLETING Questionnaire
Agency/Company Name: ___________________________
Address: ___________________________
Signature of Individual Completing the Questionnaire: ____________________________________ Date
Name: ___________________________ Telephone No.: ________________________
| Title: | ___________________________ | Email Address: | ________________________ | |
| Source Selection Information – See FAR 2.101 and 3.104 | Page | 2 |
File details come from the government source that posted it. Updated .