Attachment-2-Clinical_Centers_Past_Performance_Questionnaire.pdf

Attachment 2

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a vendor evaluation for solicitation NHLBI-HR-16-07 Please complete this Questionnaire and email or send by facsimile to:

National Institutes of Health National Heart, Lung, and Blood Institute

Office of Acquisitions, OM Attention: Sarah Bank EMAIL: sarah.bank@nih.gov

FAX: (301) 480-3338

Desired Response Date:

February 9, 2015

When complete, the information on this form is SOURCE SELECTION INFORMATION (FAR 2.101 & 3.104) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS:

2. CONTRACT NO.:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

1a: NAME OF PRIME CONTRACTOR:

6. TYPE OF CONTRACT:

(FFP,CPFF, T&M, etc.)

7. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION ( Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY

EVALUATOR:

A. Quality of Products and Services – Please provide a statement regarding the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

B. Performance – Please provide a statement regarding the contractor’s performance for the project.

C. Cost/Schedule – Please provide a statement regarding the contractor’s ability to deliver services within cost and time lines specified.

D. Customer Satisfaction - Please provide a statement regarding the contractor’s responsiveness to customer needs and their ability to effectively communicate with Government personnel throughout the period of performance.

E. Area for Improvement – If you had to describe one area for improvement, what would it be? Please state the significance.