PSA-10-RFP-0001_Attachment 4_Contractor Past Performance Survey_20101118.doc

ATTACHMENT 4

SUBSTANCE ABUSE TREATMENT SERVICES - SOLICITATION PSA-10-RFP-0001

CONTRACTOR PERFORMANCE SURVEY

The following information is for use in evaluating contract performance that has occurred or is occurring (base and option) during the last three calendar years relevant to the subject solicitation and requirement Statement of Work (SOW).

If the contract has been completed for more than three years, the information shall not be used to evaluate contractor performance.

Offeror Name: ________________________________________________________

Contract Number:

Contract Type: _____________________

Description of Service: ________________________________________________________

Agency Name: ______________________________________________________________

Name of Individual Providing Contractor Information: _______________________________

QUALITY OF SERVICE

1.

Does the contractor perform in accordance with the contract requirements and standards?_____________________________________________________________

If you answered no to question 1:

a. Was the contractor found to be non-compliant with the contract requirements during the performance period? If so, please describe. ______________________________________________________________________

b. Were the nonconformances recurring or did the contractor show improvement in performance over time?_________________________________________________

TIMELINESS OF PERFORMANCE

2.

Does the contractor adhere to contract schedules with few or no reminders about what or when services are required (i.e. court dates, transportation, etc)? ______________________________________________________________________

3.

Is the contractor responsive to technical direction and/or changing client requirements with few or no delays in performing contract requirements?

COST CONTROL

4.

Does the contractor perform the required services at the contract price with few or no adverse effects on performance?

BUSINESS RELATIONS

5.

Is the contractor cooperative with your agency regarding contract issues, concerns, requests, etc.? __________________________________________________

6.

Is the contractor responsive and timely regarding contract administrative issues, such as submission of invoices, correspondence or other required documents?

KEY PERSONNEL

7.

Does the contractor’s key personnel demonstrate an understanding of the contract requirements?

8.

Are the contractor’s key personnel effective in managing the contract (i.e., effective use of contractor personnel, quality control, etc.)?

SECURITY

9.

Does the contractor adhere to all security requirements with regards to client accountability? _________________________________________________________

10.

Does the contractor adhere to standards with regards to maintenance and sensitivity of client files? ______________________________________________________________________

CUSTOMER SATISFACTION

11.

Is the contractor proactive or reactive in their approach to customer service (i.e. providing effective notification to case managers on clients, etc.)

OVERALL RATING

12.

Overall, how would you rate this firm?

Outstanding

Very Good

Acceptable Unacceptable 13.

Would you do business with this firm again?

14.

Additional Comments/Issues: ______________________________________________________________________