RFP Attachment 1 Past Performance Questionnaire.pdf

ATTACHMENT 1 -PAST PERFORMANCE QUESTIONNAIRE

Please have your references complete this Past Performance Questionnaire and ensure that they email their response to ijk8@cdc.gov no later than the closing date of the solicitation. This questionnaire, when filled in, shall be treated as Source Selection Sensitive in accordance with FAR 3.104-3 and shall not be disclosed to anyone outside of the agency.

CONTRACTOR NAME:

The above contractor has submitted a proposal to provide technical assistance and support for Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD) Program in response to a recent solicitation. This contractor has identified your contract listed below as containing like or similar services as required under our solicitation.

BELOW------------TO BE COMPLETED BY REFERENCE

Name of respondent and role relative to the contract (e.g. Buyer, Program Manager)

Name:

Role:

Agency or Business:

Address:

Telephone Number:

Email Address:

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND WILL NOT

BE RELEASED TO THE OFFEROR.

PART I. SPECIFIC PROGRAM INFORMATION

Contract Title:

Brief Description:

Contractor’s role in the program: Prime Subcontractor Vendor/Supplier

Contract Number: Number of years:

Contract Type(s):

mailto:ijk8@cdc.gov

Competitive Contract Award? Yes No

PART II. GENERAL PROGRAM INFORMATION

Period of performance of contract or effort. Beginning Date / / through / / .

Have there been any changes to the original schedule? No

Contract dollar value:

A. Original contract value:

B. Current dollar value:

C. Primary causes of changes:

NOTE: In Part III, should your response be other than “Satisfactory”, please provide supporting documentation in “Additional Remarks” under Part IV.

PART III. PERFORMANCE ASSESSMENTS

Please check the appropriate rating below for each of the following questions:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

N/A U M S V E

1. Extent to which the Company exhibited the knowledge and skills necessary to understand and perform all technical functions as required:

2. Extent to which the Company met all requirements to deliver adequate contract deliverables:

3. Your satisfaction with the Company’s post award communication:

4. Extent to which the Company had an adequate number of dedicated resources for your program:

5. Your satisfaction with the Company’s responsiveness to the customer needs involving unscheduled requirements or contract changes:

6. Extent to which the Company managed the program to ensure subcontractor work conformed to the technical requirements:

7. Extent to which the Company met deadlines:

8. The quality of the completed product delivered by the Company:

9. Extent to which the Company met the requirements to deliver adequate reports (for example, testing results), training material, etc:

10. The company performed independently its work on the contract or effort without significant customer direction/oversight:

11. Evaluate the company’s rsponsiveness to technical direction (if applicable):

12. Completed work on time:

13. Evaluate the company’s overall performance:

PART IV. MISCELLANEOUS

1. Has this company ever defaulted on any contact or portion thereof with your company? If yes, please explain the circumstances and the resolution. (Provide additional sheets as required.)

2. Have there been any disputes or claims relative to the contract? If yes, please explain the circumstances and resolution. (Provide additional sheets as required.)

3. What were the Company’s greatest strengths/weaknesses in the performance of the contract?

4. Given the opportunity to choose other suppliers or contractors, would you choose this Company again? If not, please explain.

5. Please provide a statement describing your overall experience with the company being reviewed.

(Feel free to add additional pages of attachments). Include any information you feel may be helpful in accurately evaluating this Company’s past and/or present performance.

6. Additional Remarks (Use additional pages if necessary):

Evaluator Signature Date

ASSESSMENT RATING SYSTEM

E EXCEPTIONAL: Performance meets contractual requirements and exceeds many requirements.

The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD: Performance meets contractual requirements and exceeds some requirements.

The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY: Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL: Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE: Did not apply to this acquisition; or, questionnaire respondent has no knowledge of, and/or did not observe, the contractor’s performance in this area.