Attachment_5_-_TECHNICAL_PROPOSAL_PAST_PERFORMANCE_QUESTIONNAIRE.pdf

WR#: C102403

Rev: 06/01/17 Page 1 of 5

ATTACHMENT NO. 5 - TECHNICAL PROPOSAL

PAST PERFORMANCE QUESTIONNAIRE

Your organization has been identified for participation in past performance evaluation on a current solicitation at the National Institutes of Health (NIH) at Bethesda, Maryland. This information contained in this questionnaire will be used to evaluate the past performance for the contractor and contracting action identified below.

NIHO2017156

Inspection and QA Support Services Contract

Your candid response to the questions is important to our evaluation effort and may affect the award outcome. Please indicate "Unknown" in any area that was not applicable to work performed on your contracting action.

THE COMPLETED FORM MUST BE SUBMITTED BY MAIL, FAX OR E-MAIL TO THE

FOLLOWING ADDRESS:

Regular mail:

ATTN:

Ms. Preeti Pancholi, Contract Specialist National Institutes of Health Building 13, Room 2E48 13 South Drive, MSC 5711 Bethesda, Maryland 20892-5738

FAX:

301-402-1103

E-mail:

TO: preeti.pancholi@nih.gov CC: crawfoa@ors.od.nih.gov

If you have any questions/ concerns pertaining to this survey and/or the requested information please contact Preeti Pancholi, Contract Specialist, AECCB, National Institutes of Health, Office of Research Facilities, at 301- 451-9856.

Thank you for your time and effort in completing this survey.

mailto:ronnisha.medlin@nih.gov mailto:crawfoa@ors.od.nih.gov

Rev: 06/01/17 Page 2 of 5

PAST PERFORMANCE QUESTIONNAIRE (PPQ) for NIHOF2017156

PART I – TO BE COMPLETED BY THE OFFEROR

Offeror shall complete Part I for each Example Project submitted under Offeror’s Technical Proposal

Item Requested Information Information Provided by Contractor

A. Offeror Name:

B.

Contract / Task Order No.:

Role on Contract: [ ] Prime [ ] Subcontractor

If Subcontractor, provide Prime Contractor Name:

C.

Contract Type: [ ] IDIQ Task Order [ ]

[ ] Stan-alone / Single Award

F. Construction Complexity: [ ] Difficult [ ] Routine

I.

Brief Description of Work:

J.

Reference Organization / Agency Name:

L.

Reference Giver Name:

Title:

Telephone:

Email:

Extent of contact with Offeror personnel (daily, weekly, etc.)

Rev: 06/01/17 Page 3 of 5

PAST PERFORMANCE QUESTIONNAIRE for NIHOF2017156

PART II – TO BE COMPLETED BY OFFEROR’S REFERENCE

DEFINITIONS

Please use the following definitions when completing the Past Performance Questionnaire:

Rating Description

Essentially no doubt exists that the Offeror successfully performed the required effort based on their performance record.

Little doubt exists that the Offeror successfully performed the required effort based on their performance record.

Some doubt exists that the Offeror successfully performed the required effort based on their performance record.

2 Significant doubt exists that the Offeror successfully performed the required effort based on their performance record.

It is extremely doubtful that the Offeror successfully performed the required effort based on their performance record.

N/A The Offeror has little/no relevant past performance upon which to base a meaningful performance prediction. This indicates neither a favorable nor unfavorable rating.

INSTRUCTIONS

On a scale of 1 to 5 (5 being the highest rating) rate the Offeror’s performance for each of the items listed below. Place a ‘rating’ in the appropriate column using the definitions above.

Item Rating

Comments Please explain the rationale for each score in sufficient detail to facilitate the Technical Evaluators in their review of the survey results.

1 - Offeror’s Quality Control Did the Contractor demonstrate an interest in the quality of work of his personnel?

Did the contractor provide an adequate quality control plan and implement the plan with success?

When deficiencies were found, were they identified and corrected in a timely manner?

Overall Quality Control Rating

Rev: 06/01/17 Page 4 of 5

PAST PERFORMANCE QUESTIONNAIRE for NIHOF2017156

PART II – TO BE COMPLETED BY OFFEROR’S REFERENCE

2 – Offeror’s Timeliness Performance

Did the Contractor provide services in accordance with the performance work statement or delivery schedule(s)?

Were there any delays and if so, was resolution taken care of in a timely manner?

Overall Timeliness Rating

3 - Effectiveness of Offeror’s Management:

Did the Contractor provide experienced personnel with the technical and administrative abilities needed to meet contract requirements?

Did the Contractor hire, maintain, and replace, if necessary, qualified personnel during the contract period?

How effective was the level of communications?

Was the contractor cooperative and responsive to all concerns?

How would you rate the level of professionalism and integrity with which the Contractor conducted business?

Was there coordination and control of the Contractor’s sub-contractor base, and if problems arose, was there timely resolution?

Overall Effectiveness of Management Rating

4 – General Questions Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “Comments.”

YES________ NO_________

Rev: 06/01/17 Page 5 of 5

PAST PERFORMANCE QUESTIONNAIRE for NIHOF2017156

PART II – TO BE COMPLETED BY OFFEROR’S REFERENCE

Would you award another contract to this contractor? If not, explain in “Comments.”?

YES________ NO_________

Customer’s Overall Rating (Rating for All Categories)

If you have any comments concerning the referenced contractor which you feel would be of benefit to our evaluation for past performance, or want to explain further any answer to the above questions please provide them on this page.