Attachment J.5 - Past Performance Questionnaire.docx

Attachment J.5 – Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

Sample Cover Letter for the Offeror to send to a client(s) and/or reference(s).

[COMPANY LETTERHEAD (Prime or subcontractor)]

(insert date)

(insert client and/or reference name and Address)

SUBJECT: RFP-CMS-2017-8A-0006 – FMSG Technical Support Contractor

Dear (insert Client and/or Reference):

We are currently responding to the Centers for Medicare and Medicaid Services (CMS) Request for Quote number RFP-CMS-2017-8A-0006 The purpose of this contract is to provide Security Controls Assessments to CMS.

There is an increased emphasis on past performance in the federal source selection process. CMS is requesting that customers and clients of Offerors provide the information as described within the attached questionnaire and return it to them for evaluation. We have identified you as one of our references and respectfully request that you complete and sign the attached questionnaire and then return it to CMS.

Past Performance Questionnaires are due to Meghan Critzman, CMS Contract Specialist, Meghan.Critzman@cms.hhss.gov, with a virtual copy to Alan Fredericks, Contracting Officer, at Alan.Fredericks@cms.hhs.gov no later than EST on March 3, 2017 no later than 11am. However, we would appreciate an earlier response, if at all possible.

We sincerely appreciate your cooperation in this matter.

Sincerely, (insert the Offeror’s Point of Contact)

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C3-30-03 Baltimore, Maryland 21244-1850

Office of Acquisition and Grants Management

SUBJECT: RFP-CMS-2017-8A-0006 – FMSG Technical Support Contractor.

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. Please be advised that neither your name, nor position or organization, will be divulged either before and/or during this survey.

The questionnaire is arranged by general performance areas, e.g., quality of service/performance, cost control, timeliness, management, etc. 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 (electronic signature(s) are acceptable) 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:

Phone: (410) 786-2042 Please provide notification via phone and/or email to the Contract Specialist prior to a fax submission.

If you should have any questions, comments and/or concerns please contact Licinda Peters, Contract Specialist at (410) 786-2042 and/or email at Meghan.Critzman@cms.hhs.gov

Sincerely,

PAST PERFORMANCE QUESTIONNAIRE

RFP-CMS-2017-8A-0006 – FMSG Technical Support Contractor.

Offeror/Contractor: (insert Offeror’s name and, point of contact) Contract/Order #:

Address: (insert Offeror’s address, phone and, email address)

Please complete the following questionnaire about the Contractor (Offeror); and, indicate your responses in the blocks and/or columns, as appropriate.

Numerical ratings are as indicated in the Rating Scale below for Questions (Q) 6-11.

Note(s): Use of the term “agency” can be interpreted as either a Government and/or non-Government organization.

Please do not leave any section blank. If you are unsure and/or a question does not apply, please indicate your response as “not applicable” (N/A).

Rating Scale:

We request that you explain each of your ratings with a comment. Please be as specific in your comment as possible, especially in situations that warrant very high or very low ratings. Use extra pages as necessary or expand the form electronically as needed.

Q1. What type of Product(s)/service(s) was/are provided by the Offeror?

Q2. What type of contract(s) (Firm Fixed Price, Cost Reimbursement, Time and Material, etc.), quantity, and subtotal dollar value of each type of contract(s) do/did you have with the Offeror?

Q3. Was the contract/subcontract(s) solicited competitively or noncompetitively?

Q4. Total value of the contract/subcontract(s) with the Offeror?

Q5. Period of Performance of the contract/subcontract(s)?

b. Most

c. Half

d. Little

e. None

f. Not applicable

b. No

b. Moderately Cooperative and Responsive

c. Slightly Cooperative and Responsive

d. Slightly Uncooperative and Unresponsive

e. Moderately Uncooperative and Unresponsive

f. Highly Uncooperative and Unresponsive

g. No opinion

b. Uncertain

c. No

b. Occasionally

c. Often

d. Always or almost always

b. No

b. No

b. No

Company (reference) COMPLETING the Questionnaire

Company Name: ________________________________________________________________

Point of Contact: ___________________________ Title: ___________________________

Telephone No.: ___________________________ Email: __________________________

Note: The Questionnaire may be submitted with an electronic and/or scanned signature (information).

image1.png