Attachment_J.3-Past_Performance_Questionnaire.pdf

J.3-Past Performance Questionnaire

RFP-CMS-RMADA-2014

INSTRUCTIONS FOR QUESTIONNAIRE RESPONSE

The information from this questionnaire will be utilized in accordance with the 1994 Federal Acquisition Streamlining Act, Section 1091 to evaluate the past performance of offerors, and will augment information available via the PPIRS system.

The questionnaire is arranged by general performance areas, i.e., quality of service, cost, control, management performance. We ask that you rate the contractor on a scale of 0 through ++/5 by circling the appropriate number with 0 being unsatisfactory, 2 fair and 5 exceptional. The following table describes the rating scale in more detail:

0 Performance was extraordinarily poor and required a very high degree of management intervention

1 Below average performance with a significant number of problems in meeting requirements

2 Average performance in which all requirements were met satisfactorily with few problems

3 Above average performance with only very minor and insignificant problems

4 Performance frequently exceeded expectations

++/5 Performance was exceptional and consistently exceeded expectations

We request that you justify each of your ratings with a comment. Please be as specific in your comment as possible, especially of situations that warranted very high or very low ratings. Use extra pages as necessary.

Finally, please consider the remainder of the questionnaire by circling the appropriate answer. In addition, please sign your name and identify your position during your association with the referenced contract. Once completed, please scan and send a PDF file to: Laurie Lloyd, Contract Specialist, at: APP131181@cms.hhs.gov

Category 0 or 1 responses will be referred to the contractor to permit rebuttal. Neither your name nor position within your organization will be divulged during or after this survey has been completed.

mailto:APP131181@cms.hhs.gov

PAST PERFORMANCE QUESTIONNAIRE

Solicitation No: _____________________

Contractor: ________________________ Entity Providing Reference:

Address: __________________ Contract Person: _________________

__________________ Telephone Number: __________________

Q1. What type of product(s)/services was provided under your contract?

Q2. What type of contract?

Q3. Total value of contract:

Q4. Period of performance?

Ratings: Summarize contractor’s performance and circle in the column on the right the number which corresponds to the performance rating for each rating category, see rating Guidelines for explanation of rating scale.

0-Unsatisfactory 1-Poor 2-Fair 3-Good 4-Excellent ++Demonstrated Exceptional Performance Q5. How was the contractor’s quality of products/services?

(compliance with contract requirements-accuracy of reports submitted-technical excellent/appropriateness of personnel)

Comments: Rating:

Q6. How well did the contractor control costs?

(written budget (over/under target costs)-contractor provided current, accurate and complete billings-relationships of negotiated costs to actual-cost efficiencies)

Comments: Rating:

Q7. How well did the contractor comply with timeliness?

(did contractor meet interim milestones-reliable-responsive to technical direction-met all delivery schedules on time)

Comments: Rating:

Q8. How well did the contractor work with project/contracting officers?

(prompt notification of problems-reasonable, cooperative, flexible-proactive-responsive to contract requirements-recommended solutions)

Comments: Rating:

Q9. How would you describe the contractor’s commitment to customer satisfaction?

(how well did the contractor interface with the end user of the product/service)

Comments: Rating:

Q10. How well do you assess the contractor’s key personnel?

(how long did key personnel stay on contract-did they effectively manage contract-were they responsive to technical direction)

Comments: Rating:

Q11. Did excessive turn- over of employees affect the contractor’s performance or your relationship with the contractor's staff?

a. Yes

b. No

Q12. If there was a cost overrun (delivery delays), in your opinion, how much of the problem/delay was attributable to contractor’s mismanagement?

a. All

b. Most

c. Half

d. Little

e. None

f. Not Applicable

Q13. Based on your experience with this contractor, do you think it can be relied upon to deliver quality products/services by a specific delivery date?

Q14. Do you believe the contractor can be relied upon to control the cost of performance?

b. Uncertain

c. No

Q15. How cooperative was the contractor when technical problems were encountered during the performance of the contract?

a. Highly cooperative

b. Moderately cooperative

c. Slightly cooperative

d. Slightly uncooperative

e. Moderately uncooperative

f. Highly uncooperative

g. No opinion

Q16. How frequently did you have to direct the contractor to re-perform the service because it had been performed unsatisfactorily the first time?

a. None

b. Occasionally

c. Often

d. Always, or almost always

Q17.Was this contractor’s performance generally satisfactory?

Q18. Would you utilize this contractor again?

Q19.Would you recommend this contractor to others?

Q20.Any other comments regarding the contractor’s performance?

Comments:

PRINT NAME: ________________________________

SIGNATURE: _________________________________

TITLE: _______________________________________

DATE: ________________________________________

PRINT NAME: ________________________________