Attachment9.doc

ATTACHMENT 9

PAST PERFORMANCE QUESTIONNAIRE

Procurement Sensitive

See FAR 3.104

TO:

FACSIMILE:

PHONE:

EMAIL:_____________________

INFORMATION REQUEST

PAST PERFORMANCE

The National Institutes of Health (NIH) is currently in the process of soliciting proposals for RFP Number NIHOD2008052 [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR’S NAME] record of past performance under Contract No. [CONTRACT NUMBER]. Specifically, we are looking for past performance information in the following areas:

a.) Quality of Product or Service b.) Timeliness or Scheduling of Service/Deliveries c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing e.) Cost Control (COST CONTRACTS ONLY)

In order for our team to compile its evaluation, we request that you complete the attached survey form, in addition to any other pertinent information and either fax, or email it to Mr. Ronald Banzon:

Email: banzonr@od.nih.gov Fax: (301) 402-3407 Any relevant information you have would be vital in our assessment of the aforementioned Contractor.

For your convenience, a cover sheet for use in faxing is provided below.

National Institutes of Health Attn Ronald Banzon, Contract Specialist

From:

(Name and Address of Customer __________________________________________________

Company/Customer Agency)

(Point of Contact Name)

(Facsimile/Phone Number)

(E-mail Address)

To (Point of Contact Name)

Ronald Banzon (/Phone Number)

(301) 402-0716

(E-mail Address) banzonr@od.nih.gov

CONTRACTOR PERFORMANCE EVALUATION SURVEY

CONTRACTOR NAME:

CONTRACT NUMBER:

EVALUATION PERIOD:

DELIVERY ORDER NO.:

1.

Please describe the service/supply provided by the Contractor to your firm/agency.

2. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional (E), Very Good (VG), Satisfactory(S), Marginal (M), or Unsatisfactory (U) with a point score. DO NOT CHECK OR X BOXES, PLEASE PUT IN A WHOLE NUMERICAL SCORE (For example an Exceptional would receive a 9 or a 10). See next page for definition of ratings. For ratings of “Exceptional” or “Unsatisfactory,” please provide a brief explanation.

EXCEPTIONAL

9-10

VERY GOOD

7-8

SATISFACTORY

5-6

MARGINAL

3-4

UNSATISFACTORY

0-2

OVERALL PAST PERFORMANCE RATING

Please provide an overall rating of the contractor’s past performance for the referenced contract/delivery order.

a.) Quality of Product or Service:

b.) Timeliness or Scheduling of Service/Deliveries:

c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing

3.

Would you hire this contractor to provide services for your organization in the future? Please provide comments using additional pages if desired.

Signed:__________________________________

CONTRACTOR PERFORMANCE EVALUATION SURVEY CONTINUED

DEFINITION OF RATINGS FOR PAST PERFORMANCE

Exceptional: Performance met and exceeded many contractual requirements to the customer’s benefit. Performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. The Offeror’s past performance record, considering past performance and relevance to the instant procurement, leads to an extremely strong expectation of successful performance.

Very Good: Performance met and exceeded some contractual requirements to the customer’s benefit. Performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. Offeror’s past performance record, considering past performance and relevance to the instant procurement, leads to a strong expectation of successful performance.

Satisfactory: Performance met contractual requirements. Performance being assessed contained some minor problems for which corrective actions taken by the contractor appeared to be or were satisfactory. Offeror’s past performance record, considering past performance and relevance to the instant procurement, leads to an expectation of successful performance.

Marginal: Performance did not meet some contractual requirements. Performance being assessed reflected a serious problem for which the contractor did not identify corrective actions. The contractor’s proposed actions were only marginally effective or were not fully implemented. Offeror’s past performance record, considering past performance and relevance to the instant procurement, leads to an expectation that successful performance might be difficult to achieve or that it can occur only with increased levels of Government management/oversight.

Unsatisfactory: Performance did not meet most contractual requirements and recovery did not occur in a timely manner. Performance being assessed contained serious problem(s) for which the contractor’s corrective actions appeared or were ineffective. Offeror’s past performance record, considering past performance and relevance to the instant procurement, leads to an extremely strong expectation that successful performance will not be achieved.

Attachment 9