Attachment 5 -- Past Performance Questionnaire.pdf

Past Performance Questionnaire

The Offeror will forward two copies of the Past Performance Questionnaire to each reference identified for the representative projects. Reference providers are to review the attached survey and respond to each of the survey questions on the Customer Satisfaction Survey, preferably with comments supporting the reviewer’s score. The survey provider is to forward one copy of the response to the Contracting Officer, either using e-mail, or fax and another copy to the Offeror for inclusion in the technical proposal. When faxing or e-mailing the questionnaire, include an explanatory cover sheet (briefly describing the procurement) and complete as much of the basic information portion of the questionnaire as possible. It is important that all information on the form be completed, unless the information is not relevant or simply is not available. No phone responses will be accepted.

E-mail or fax responses to:

Attention : Aaron Crawford, Contracting Officer e-mail: crawfoa@ors.od.nih.gov

Fax: 301-402-1103 mailto:crawfoa@ors.od.nih.gov�

PAST PERFORMANCE REFERENCE QUESTIONNAIRE

Item Requested Information Information Provided by Reference

A.

Contractor Name

Contractor Address

B.

Contract Number

Task Order Number

Prime/Subcontractor [ ] Prime [ ] Subcontractor

If Subcontractor, Prime Contractor Name

C.

Contract Type [ ] Competitive [ ] Sole Source

[ ] IDIQ Task Order [ ] Other

[ ] Fixed Price or Fixed Unit Price [ ] T&M or Cost Reimbursement

D.

Task Order Type [ ] Fixed Price (Lump Sum)

[ ] T&M or Cost Reimbursement

E.

Initial Performance Dates From: To:

Extensions From: To:

F.

Initial Costs $

Extensions $

Total $

G.

Work Complexity [ ] Difficult [ ] Routine

H.

Contract/Order Canceled Prior to Scheduled Completion Date?

[ ] Yes [ ] No

I.

Brief Description of System(s)/ User Environment/ Work (Attach additional pages as necessary)

J.

Reference Organization / Agency Name

K.

Reference Organization Work Functions

L. Services Geographic Area [ ] Local [ ] County [ ] State [ ] National

Number of Locations

M. Reference Giver - Name

Title

Address

Telephone

Fax

Role in acquisition process

Extent of contact with vendor personnel (e.g.

daily, weekly, etc.)

N. Reference Questions See Attached Table

O. Comments

(Attach additional pages as necessary)

P. DHHS Reference Taker - Name

Contact Date (If taken over the Telephone)

Disclaimer - The Offeror shall hold the Customer harmless for information provided in this survey and any information relating to this survey requested by the Government or its representative..

CUSTOMER SATISFACTION SURVEY

SOLICITATION NUMBER NIHOF2010227

Item On a scale of 1 to 5 (5 being the highest rating) How do you rate the Offeror’s...?

Rating Comments Please explain the rationale for each score in sufficient detail to facilitate the Technical Evaluators in their review of the survey results. Please indicate if an item is not applicable to the representative project.

(1) What is the overall customer satisfaction?

(2) How would you rate the level of professionalism and integrity with which they conducted business?

(3) What was the level of responsiveness to the clients and needs and expectations?

(4) How would you rate the professional technical capabilities?

(5) How effective was the level of communications?

(6) How would you rate the quality control of construction?

(7) Was there effectiveness in forecasting and controlling costs?

(8) What was the level of accuracy in forecasting and controlling schedules?

(9) What was the level of the staff competence and administrative skills?

(10) How would you rate their experience and capability in utilizing Building Information Model (BIM)?

(11) How would rate the level of cooperation during the building commissioning process?

(12) How would rate the level of coordination provided during the occupancy/activation process?

Average Rating 0.00