Attachment_J.3.2_-_Past_Performance_Questionnaire_CO_Letter.pdf

RFP-CMS-2016-8A-0008

Attachment J.3.2 Past Performance Questionnaire

Source Selection Information – See FAR 2.101 and 3.104

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard, Mail Stop B2-14-21

Baltimore, Maryland 21244-1850

Office of Acquisition and Grants Management

SUBJECT: Solicitation RFP-CMS-2016-8A-0008 – Workers Compensation Review

Contractor Questionnaire

To Whom It May Concern:

The Centers for Medicare & Medicaid Services (CMS) very much appreciates your time and thoughtfulness in completing the attached questionnaire. The information obtained from this questionnaire will be utilized to evaluate the past performance of Offerors/Contractors who wish to be awarded a contract with CMS.

CMS may engage in exchanges with offerors regarding past performance information submitted to CMS in connection with the subject solicitation. If CMS engages in such exchanges, CMS may share information disclosed in this survey with the Offeror to whom it pertains, as permitted or required by the FAR. Otherwise, CMS will only share information from this survey outside the agency pursuant to a protective order or as otherwise required by law

The questionnaire is arranged by quality, cost control, schedule, and management. Each area consists of a few basic questions relating to these aspects of performance with regard to the

Offeror/Contractor with which you worked. Please complete the questionnaire as indicated on the form.

Finally, please sign your name and identify your position during your association with the referenced Offeror/Contractor. Once completed, please submit the questionnaire in one of the following manners:

Email PDF (Preferred): stephen.stoyer@cms.hhs.gov debra.stidham@cms.hhs.gov

Fax Original: (Please call or email for fax number if you want to fax the questionnaire)

Mail Original: Centers for Medicare & Medicaid Services

Office of Acquisition and Grants Management

Division of Western Medicare Administrative Contracts

ATTN: Debra Stidham

410-786-5129

Contracting Officer

7500 Security Blvd., Mailstop B2-14-21

Baltimore, MD 21244-1850 mailto:stephen.stoyer@cms.hhs.gov mailto:debra.stidham@cms.hhs.gov

RFP-CMS-2016-8A-0008

Attachment J.3.2 Past Performance Questionnaire

Source Selection Information – See FAR 2.101 and 3.104

Thank you for taking the time to complete the questionnaire.

Sincerely, Debra Stidham

Contracting Officer