RRB17Q0002_MDS_PPQ_Attachment._1.docx
DOCX document 23 KB Posted
- Attached to
- Medical Directorship services -- D
- Solicitation number
- RRB17Q0002
- Issued by
-
Railroad Retirement Board
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Past Performance Questionnaire
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| File | Type | Posted |
|---|---|---|
| RRB17Q0002_RFQ_MDS_Final.pdf |
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Text version
Solicitation No. RRB17Q0002 Page 2 of 2 Attachment 1 Medical Directorship Services
PAST PERFORMANCE QUESTIONNAIRE & PERFORMANCE EVALUATION FORM
Name of Evaluator: ________________________________
Official Position: ________________________________
Name of Company: ________________________________
Company Address: ________________________________
Phone - Email: ________________________________
Name of Contractor ________________________________
Period of Performance: ________________________________
| Contract No. or | |
| Reference’s Name | ________________________________ |
Contract Type: ________________________________
Contract Value: ________________________________
Please provide a thorough and complete description of the most recent services you have contracted for from the vendor.
INSTRUCTIONS – For each item, circle the rating that best describes the contractor’s work on this project and provide any additional comments. For items not applicable to your project, please indicate N/A.
| 5= Excellent | No problems, issues, or delays in achieving contract requirements | ||
| 4= Good | Does not impact achievement of contract requirements | ||
| 3=Satisfactory | Requires minor agency resources to ensure achievement of contract requirements | ||
| 2=Marginal | Requires major agency resources to ensure achievement of contract requirements | ||
| 1= Unsatisfactory | Achievement of contract requirement is compromised | ||
| For Yes or No Questions: | 5=Yes & 1=No | ||
| N/A= Not applicable | Does not apply |
(1) Overall implementation of the contract? 5 4 3 2 1 N/A
Comments:
(2) Ability to pro-actively and aggressively perform 5 4 3 2 1 N/A contract requirements and quality of service?
(3) Effectiveness and reliability of contractor's key personnel? 5 4 3 2 1 N/A
| (4) Timeliness of performance, reliability, and ability to meet | 5 | 4 | 3 | 2 | 1 | N/A |
| contractually established deadlines. |
| (5) | Customer satisfaction; was the contractor’s staff responsive, | 5 | 4 | 3 | 2 | 1 | N/A |
| cooperative, and effective in working with your staff, and | |||||||
| were there an adequate number of staff resources? |
| (6) | Effectiveness in interfacing with agency or organization | 5 | 4 | 3 | 2 | 1 | N/A |
| personnel. |
| (7) | Overall business relations with your agency or organization, | 5 | 4 | 3 | 2 | 1 | N/A |
| and the contractors ability to effectively respond to inquiries. |
| (8) | Quality of the contractor’s billing procedures, | 5 | 4 | 3 | 2 | 1 | N/A |
| billing accuracy and resolution of billing discrepancies. |
| (9) | Ability to meet agency’s or organization’s security | 5 | 4 | 3 | 2 | 1 | N/A | |
| requirements. |
(10) Rate the contractor’s overall technical competence. 5 4 3 2 1 N/A
| (11) | Based on this contractor’s overall performance, | 5 | 4 | 3 | 2 | 1 | N/A |
| would you award this contractor a similar contract? |
File details come from the government source that posted it. Updated .