Amend3_Attachment23_PastPerformanceQuestionnaire.pdf

RFP No. NIHCL2017072

NIH CC Patient Call Communication System

Attachment No. 23

Past Performance Questionnaire

(To be completed by Contractor’s client/customer)

INSTRUCTIONS:

The questions contained below are to be used to evaluate the performance record of a contractor submitting a proposal in response to RFP No. NIHCL2017072 issued by the National Institutes of

Health Clinical Center.

Please complete this performance questionnaire and return via e-mail to:

Rieka Plugge, Contract Specialist

National Institutes of Health Clinical Center

Office of Acquisitions

E-mail: rieka.plugge@nih.gov

Before June 13, 2017. Your responses to this questionnaire will be considered confidential, except as explained below. Responses returned by contractors will not be used in the performance evaluation. For the purposes of this survey, “Contractor” refers to the specific contractor that requested you to provide this information to the Government.

For each of the following areas, rate the performance of the Contractor as (5) Outstanding; (4)

Excellent; (3) Good; (2) Fair; (1) Poor; (0) Unsatisfactory; or (N/A) Not Applicable. Indicate your rating by circling the appropriate number.

Include a narrative explanation whenever you feel that it is appropriate, but as a minimum when a rating of “Unsatisfactory” is given. Please note that if an “Unsatisfactory” rating is given, the contractor will be made aware of it and will be asked to comment.

mailto:rieka.plugge@nih.gov

This survey pertains to: _________________________________________________________

Department/Component: _______________________________________________________

Award Number: _______________________________________________________________

Date of Survey: ________________________________________________________________

Name of Person Completing Survey: ______________________________________________

Your Company/Agency: ________________________________________________________

Your Role in this Award (circle one):

Contracting Officer Contract Specialist Project Officer Other

Contract Value (including options if applicable): $___________________________________

Performance Period (including options if applicable): ________________________________

Type of Contract: ______________________________________________________________

Please provide applicable subcontractor(s) information.

1. Subcontractor: __________________________________________________________

Program Manager/Phone: _________________________________________________

2. Subcontractor: __________________________________________________________

3. Subcontractor: __________________________________________________________

4. Subcontractor: __________________________________________________________

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support rating shall be noted on page 4.

Assign each area a rating of 0 (Unsatisfactory), 1 (Poor), 2 (Fair), 3 (Good), 4 (Excellent), or 5 (Outstanding).

Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle

"N/A" (not applicable/no opinion).

QUALITY OF SERVICE (WAS ORDER RECEIVED PROMPTLY AND COMPLETE)

1. Compliance with contract requirements 0 1 2 3 4 5 N/A

2. Accuracy of reports 0 1 2 3 4 5 N/A

3. Effectiveness of personnel 0 1 2 3 4 5 N/A

4. Technical Excellence 0 1 2 3 4 5 N/A

TIMELINESS OF DELIVERY

1. Met interim milestones 0 1 2 3 4 5 N/A

2. Reliability 0 1 2 3 4 5 N/A

3. Responsive to technical direction 0 1 2 3 4 5 N/A

4. Completed on time including wrap-up and contract administration

0 1 2 3 4 5 N/A

5. Met delivery schedules 0 1 2 3 4 5 N/A

6. Timely, current & complete reporting, tracking & documentation

0 1 2 3 4 5 N/A

BUSINESS RELATIONS

1. Effective management 0 1 2 3 4 5 N/A

2. Reasonable/cooperative behavior 0 1 2 3 4 5 N/A

3. Responsive to requirements 0 1 2 3 4 5 N/A

4. Notification of problems 0 1 2 3 4 5 N/A

5. Flexibility 0 1 2 3 4 5 N/A

6. Pro-active vs. reactive 0 1 2 3 4 5 N/A

CUSTOMER SATISFACTION

1. The contractor is committed to customer satisfaction. Yes No

2. Would you recommend selection of this firm again? Yes No

ADDITIONAL COMMENTS:

Rating Guidelines

QUALITY OF PRODUCT

OR SERVICE

TIMELINESS OF

PERFORMANCE

BUSINESS

RELATIONS

0-Unsatisfactory

Contractor is not in compliance and is jeopardizing achievement of contract objectives

Contractor delays are jeopardizing performance of contract objectives

Response to inquiries, technical/ service/ administrative issues is not effective

1-Poor

Major problems have been encountered

Contractor is having major difficulty meeting milestones and delivery schedule

Response to inquiries, technical/ service/ marginally effective

2-Fair

Some problems have been encountered

Contractor is having some problems meeting

Response to inquiries, technical/ service/ somewhat effective

3-Good

Minor inefficiencies/ errors have been identified

Contractor is usually effective in meeting service/ usually effective

4-Excellent

Contractor is in compliance with contract requirements and/or delivers quality products/services

Contractor is effective in meeting milestones and delivery schedule service/ effective

Signature: ______________________ Organization: ________________

Name/Title: __________________________ Date: ___________________