Past Performance Survey_Sol 75H70726Q00061.docx
DOCX document 398 KB Posted
- Attached to
- Solicitation 75H70726Q00061-Pest Control Services for Zuni Comprehensive Community Health Center (ZCCHC)
- Solicitation number
- Solicitation_75H70726Q00061
About this file
This is a Past Performance Survey form for Solicitation 75H70726Q00061, a pest control services requirement issued by the Department of Health and Human Services Indian Health Service for the Zuni Comprehensive Community Health Center. The survey is used to evaluate contractor references and assess past performance across five key categories: Quality of Service, Cost Control, Timeliness of Performance, Business Relations, and Customer Satisfaction. Each category contains specific performance metrics rated on a five-point scale (Excellent, Good, Acceptable, Marginal, Unacceptable), with overall ratings combined to determine a final past performance score that influences source selection.
The survey requests detailed information about referenced contracts including contract type, end products, client background, planning and staffing requirements, and timeline compliance. Respondents provide objective ratings on factors such as compliance with contract requirements, accuracy of reports, personnel effectiveness, technical excellence, cost forecasting and control, milestone achievement, timeliness of delivery, management effectiveness, business conduct, and overall customer satisfaction. The form also includes space for narrative comments supporting assigned ratings. This template is part of the broader solicitation for commercial pest control services that is set-aside for Indian Small Business Economic Enterprises (ISBEEs) with cascading tiers for alternative eligible contractors, with quotations due June 23, 2026, by 3:00 PM Mountain Time.
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Other files
| File | Type | Posted |
|---|---|---|
| QA_.docx | DOCX document | |
| Pricing table_.docx | DOCX document | |
| Sol_75H70726Q00061 terms and conditions.pdf | ||
| IHS IEE Representation Form_Jan 2022_508 Compliant.pdf |
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Text version
Section 14
| DEPARTMENT OF HEALTH AND HUMAN SERVICES | |
| Indian Health Service |
Past Performance Survey Solicitation No.: 75H70726Q00061 Pest Control Services
Contractor Name: CLIENT INFORMATION
Commercial Client Federal Client Client Name:
Client Address:
City State Zip Code Project Name:
Contract Number(s): Total Contract Value: Performance Period: Teaming Partner(s):
Government or Commercial Project Manager Contact
Alternate Government or Commercial Project Manager Contact
Name: Name: Title: Title: Phone number: Phone number: Fax number: Fax number: E-mail address: __ E-mail address:
SPECIFIC PERFORMANCE
Instructions: This part consists of open-ended questions to determine the scope, complexity, and relevance of the contract to the current requirements. Please answer the questions concisely and to the best of your knowledge.
1. Describe the overall contract type the contractor provided.
2. Describe the end goal/end product and result.
3. Describe the general background type of the patients served in performing this task.
4. Describe the level of planning and staffing contractor was required to perform and if they met the contracts exceptions.
5. Describe the average timeline involved in completing this contract and if contractor met that timeline within reason.
SOURCE SELECTION SENSITIVE NOT FOR PUBLIC RELEASE
Past Performance Survey
PAST PERFORMANCE RATINGS
Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Comments to support ratings may be noted on last page. The Government will assess an overall past performance rating for each reference contacted. The overall ratings of each reference will then be combined to arrive at a final past performance rating that will be assigned points based upon the following rating scheme:
RATINGS ARE DEFINED AS FOLLOWS:
Definition Description
Excellent The Contractor demonstrates an excellent performance level in all categories. There have been no performance problems and the Contractor has demonstrated initiative to enhance/exceed contractual requirements and objectives. The Contractor also has maintained an excellent Contractor/Government relationship throughout contract performance
Good There are no quality-of-service problems; no cost/price issues; and no delays. Responses to inquiries and technical/service administrative issues are consistently effective and responsive. Non-conformance does not impact achievement of contract requirements.
Acceptable Non-conformances are minor and have little impact in achievement of contract requirements, requires minor intervention by Government personnel to resolve issues.
Marginal Non-conformances are impacting achievement of contract requirements, requires substantial intervention by Government personnel to resolve issues.
Unacceptable Non-conformances are compromising the achievement of contract requirements, despite substantive intervention by Government personnel.
SOURCE SELECTION SENSITIVE NOT FOR PUBLIC RELEASE
PART 1: GENERAL PERFORMANCE
INSTRUCTIONS: PLEASE CHECK THE APPROPRIATE RATING
| Quality of Service |
| Excellent |
| Good |
| Acceptable |
| Marginal |
| Unacceptable |
| N/A |
1. Compliance with contract requirements
2. Accuracy of Reports
3. Effectiveness of Personnel
4. Technical Excellence
5. Record of conforming to specifications and standards of good workmanship
6. Ability to provide services nationwide, including small and rural communities
| Cost Control |
| Excellent |
| Good |
| Acceptable |
| Marginal |
| Unacceptable |
| N/A |
1. Record of forecasting and controlling target costs
2. Current, accurate, and complete billings
3. Relationship of negotiated costs to actual
4. Cost efficiencies
| Timeliness of Performance |
| Excellent |
| Good |
| Acceptable |
| Marginal |
| Unacceptable |
| N/A |
1. Met interim milestones
2. Reliability
3. Responsive to technical direction
4. Completed on time including wrap up
5. Met delivery schedules
6. Amount of Liquidated Damages
Past Performance Survey
SOURCE SELECTION SENSITIVE NOT FOR PUBLIC RELEASE
(Excellent=Low or None, Unacceptable= High)
| Business Relations |
| Excellent |
| Good |
| Acceptable |
| Marginal |
| Unacceptable |
| N/A |
1. Effective Management, including subcontracts
2. Reasonable/cooperative behavior
3. Responsive to contract requirements
4. Notification of problems
5. Flexibility
6. Pro-active vs. Reactive
7. Effective small/small disadvantage business subcontracting program
8. History of staff turnover
| Customer Satisfaction |
| Excellent |
| Good |
| Acceptable |
| Marginal |
| Unacceptable |
| N/A |
1. Commitment to customer satisfaction
2. Would you recommend selection of this firm again?
3. Overall Rating of Contractor
ADDITIONAL COMMENTS:
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