ATTACHMENT_3_-_amendment_2EPAP_PAST_PERFORMANCE.docx

PART I – Past Performance Contact Information [to be completed by Offeror] Instructions: The Offeror shall complete Part I of this Attachment for each past performance reference. The Vendor shall forward this form (with a completed Part I) to each of its references for completion, with instructions to forward the completed questionnaire to the Contracting Officer (NOT BACK TO THE VENDOR) before the time set for receipt of proposals. Each reference should be similar in scope, size, and complexity to the requirements outlined in the accompanying RFQ. The completed questionnaires should be forwarded by email directly from the Vendor’s reference prior to the time for receipt of proposals to Jonah Lerman at Jonah.Lerman@hhs.gov.

Vendor Information:

Name of Vendor Providing Services: ____________________________________________ Address: ____________________________________________________________________

Past Performance Reference Information:

Name of Agency/Organization Receiving Services:

Address: _____________________________________________________________________

Telephone: _________________________ FAX: _____________________________ Contract Information:

Contract Number: _____________________ Dollar Value (Annual): _______________

Performance Period: ___________________ Performance Location: _______________

Type of Contract (Check all that apply):

Fixed Price ______ Cost Reimbursement ______ Other (specify) _________________

Brief Description of Services Provided: ________________________________________________

Part II - To be completed by the offeror’s reference

1. What were you experiences with the quality of the services provided by this Contractor?

Bold or Underline a Rating: 1 2 3 4 5 6 7 8 9 10 N/A

2. What were your experiences with the Contractor’s adherence to contract schedules?

3. What were you experiences with the Contractor’s overall ability to meet schedules for delivery of reports?

4. What were you experiences with the Contractor’s ability to meet any special requirements for expedited delivery or service?

5. What were your experiences with the Contractor’s conforming to contract requirements generally?

6. What were your experiences with the Contractor’s standards of professionalism?

7. What were your experiences with the Contractor’s controlling costs and working with you to limit additional costs and, if you are a Government agency, to limit upward equitable adjustments to the Government’s price in the event of changes?

8. What were your experiences with the Contractor’s integrity and business ethics?

9. What were your experiences with the Contractor’s spirit of cooperation and fairness of business dealing with you?

10. What were your experiences with the Contractor’s commitment to your satisfaction as a customer and concern for your business interests?

11. What were your experiences with the Contractor’s reporting into Government databases to which it was obliged to report?