RFP ONLY - Attachment 05 - Past Performance Questionnaire.docx

SOLICITATION: 70CDCR21R00000008

US DEPARTMENT OF HOMELAND SECURITY

IMMIGRATION AND CUSTOMS ENFORCEMENT

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

[Offeror] is proposing on a U.S. Department of Homeland Security (DHS), Immigration and Customs Enforcement (ICE) Indefinite Delivery Indefinite Quantity (IDIQ) request to provide Medical Staffing Services to meet the mission needs of ICE. [Offeror] has provided ICE with your contact information as a reference for their Past Performance. Past Performance is an extremely important part of the evaluation criteria for this acquisition, so your input is very important. The information contained in this Past Performance Questionnaire is to be provided directly to the OAQDCRSW@ice.dhs.gov. This information will not be disclosed to the respondent. Please provide an honest assessment of the vendors performance and return this questionnaire to ICE no later than [TBD] email to OAQDCRSW@ice.dhs.gov. If you have any questions, please contact Ian Somppi or Brittany Tobias by email at Ian.Somppi@ice.dhs.gov or Brittany.Tobias@ice.dhs.gov.

Please utilize the following rating system during the completion of this questionnaire:

PART TWO: GENERAL INFORMATION

Respondent’s Name:

Respondent’s Title:

Contract Number:

Contract Value:

Contract Award Date:

Contract Period of Performance:

Contract Type (Fixed Price, Time and Materials, etc.):

PART THREE: ASSESSMENT ELEMENTS

Place an “X” in the appropriate box next to the letter for each item on the questionnaire. Narrative statements are vital. Please provide a supporting narrative for each area. Attach additional pages if there is insufficient space in the comment space.

1. Rate the contractor’s Quality of Services provided:

E |_| V |_| S |_| M |_| U |_| N |_| Comments for Question 1:

2. Rate the contractor’s success in meeting Contract Schedules (qualified staffing, delivery of reports, performance of services):

E |_| V |_| S |_| M |_| U |_| N |_|

Comments for Question 2:

3. Rate the contractor’s management of Key Personnel:

E |_| V |_| S |_| M |_| U |_| N |_| Comments for Question 3:

4. Have you experienced any problems with the contractor’s failure to fully staff required positions?

YES |_| NO |_|

5. Did the contractor take reasonable actions to correct the staffing shortages? Was the contractor able to solve contract performance problems without extensive guidance from counterparts?

YES |_| NO |_|

Comments for Question 5:

6. Please identify what you believe the contractor’s strengths to be.

7. Please identify what you believe the contractor’s weaknesses to be.

8. Has this contract been partially or completely terminated for default or convenience or are there any pending terminations?

YES |_| NO |_| DEFAULT |_| CONVENIENCE |_|

If yes, explain (e.g., inability to meet cost, performance, or delivery schedules).

9. Did the contractor comply with subcontracting plan goals for small disadvantaged business (SDB) concerns

YES |_| NO |_|

Comments for Question 9:

10. Given the choice, would you award to this contractor again?

YES |_| NO |_|

11. Explain why you would not enter into another contract with this company.