past_performance_questionnaire.doc

PAST PERFORMANCE INFORMATION

NIH CONTRACTOR PERFORMANCE RFQ CUSTOMER SURVEY QUESTIONNAIRE

Please complete the following questionnaire and return via regular mail or fax to the attention of:

Mary Rainey, Contract Specialist by

(Name) (Date) 6011 Executive Blvd, Rockville MD (Address) (Fax Number) Phone # E-Mail 301-402-3407

301-594-4101 raineyml@od.nih.gov

This survey pertains to:

Department/Component:

Contract Number: Date of Survey:

Name of Person Completing Survey: ________________________________ Signature of Person Completing Survey: ________________________________ Your Company/Agency: _____________________________________________ Your Role in this Contract (circle one):

Contracting Officer Contract Specialist Project Officer Other Contract Value (including options): $ ___________________________________ Performance Period: ____________________________ (including option periods) Type of Contract: _________________________________________________ Approximate percentage of work being performed (or completed) by subcontractor(s): %

Information on subcontractor(s) (where more than % of work was completed by the subcontractor):

Subcontractor

Program Manager

Phone

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

1.

Compliance with contract requirements

N/A

2.

Accuracy of reports

N/A

3.

Effectiveness of personnel

N/A

4.

Technical Excellence

N/A

COST CONTROL

Record of forecasting and controlling target costs

N/A

2.

Current, accurate and complete billings

N/A

3.

Relationship of negotiated costs to actuals

N/A

4.

Cost efficiencies

TIMELINESS OF PERFORMANCE

Met interim milestones

N/A

2.

Reliability

N/A

3.

Responsive to technical direction

N/A

4.

Completed on time including wrap-up and contract administration

N/A

5.

Met delivery schedules

N/A

6.

Liquidated damages assessed: Yes No (circle one)

BUSINESS RELATIONS

Effective management, including management of subcontracts

N/A

2.

Reasonable/cooperative behavior

N/A

3.

Responsive to contract requirements

N/A

4.

Notification of problems

N/A

5.

Flexibility

N/A

6.

Pro-active vs reactive

N/A

7.

Effective small/small disadvantaged business subcontracting program

CUSTOMER SATISFACTION

The contractor is committed to customer satisfaction.

Yes No (circle one) 2.

Would you recommend selection of this firm again?

Yes No (circle one)

ADDITIONAL COMMENTS

Rating Guidelines

service/ administrative issues is not effective

service/ administrative issues is marginally effective

inquiries, technical/ service/ administrative issues is somewhat effective

errors have been identified

inquiries, technical/ service/ administrative issues is usually effective

inquiries, technical/ service/ administrative issues is effective

5-Outstanding: The contractor has demonstrated an outstanding performance level in any of the above four categories that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances when contractor performance clearly exceeds the performance levels described as "Excellent."

OMB Clearance No. 9000-0142 Source Selection Information