Section J Attachment E - Past Perf. Quest. Letter.docx

HRSA Evidence-Building and Evaluation Services IDIQ Section J Attachment E

PAST PERFORMANCE QUESTIONNAIRE LETTER

Date:

Dear Client:

We are currently responding to the Health Resources and Services Administration (HRSA) Solicitation No. RFP 75R60224R00003 entitled, HRSA Evaluation & Evidence Building IDIQ. The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

Email: HRSAIDIQ@hrsa.gov

RFP #75R60224R00003

Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above email address no later than the closing date of the Request for Proposal.

We thank you for your prompt response in this matter.

Sincerely, (To be signed by offeror)

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

For: __________________________________________________________________ Name of Company

Please Return Completed Survey To:

Email: HRSAIDIQ@hrsa.gov

Please Fill In The Following:

Your Name: __________________________________________ Your Agency: _________________________________________ Address: _____________________________________________ Phone Number: ________________________________________ Fax Number: __________________________________________

Signature of Person Completing Survey: _________________________________

Contract Number / Solicitation Number: ________________________________

Your Role In This Contract (circle one)

Project Officer

Contracting Officer

Contract Specialist

Approximate Percentage of Work Competed by Subcontractors: _______ %

General Description or work or Title of Contract: _______________________________________________________________________

Standard Contractor Performance Report

Contract Type:

Contract Number / Order Number:

Contractor Name:

Contract Award Date:

Contract Expiration Date:

Contract Value:

Supplies or Services:

Ratings

Summarize contractor performance and check the selection which corresponds to the rating for each rating category (See attached Rating Guidelines). Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Quality of Product or Service:

Government Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Firm Fixed Price):

Timeliness of Performance:

Business Relations:

Additional Info

Subcontracts:

Are subcontracts involved? ____Yes ____No (Check one)

Comment on subcontracts (2000 characters maximum):

Customer Satisfaction:

Is / was the contractor committed to customer satisfaction? ____ Yes ____ No (Check one)

Would you recommend the selection of this firm again? ____ Yes ____ No (Check one)

Comments on Customer Satisfaction (2000 characters maximum):

Admin Info

Project Officer / COR Name:

Phone:

Fax:

E-mail Address:

Contracting Officer:

Name:

Phone:

Fax:

E-mail Address:

Rating Guidelines

Quality of Product or Service

Cost Control

Timeliness of Performance

Business Relations