Past_Performance_Questionnaire_CI_Medical_for_IRS.doc

DOC document 68 KB Posted Jan 30, 2014

Attached to: CI Medical Services
Solicitation number: TIRNO-13-R-00032
Issued by: Department of the Treasury Internal Revenue Service

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PAST PERFORMANCE QUESTIONNAIRE

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CI_Medical_-_Non-Disclosure_Agreement.doc	DOC document	Jan 30, 2014

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PAST PERFORMANCE INFORMATION

SCHEDULE CONTRACTOR PERFORMANCE CUSTOMER SURVEY QUESTIONNAIRE

Please complete the following questionnaire and return it directly to the Internal Revenue Service. Questionnaires should be returned via email to the attention of the individual named below, no later than February 25, 2014 at 4:00 pm, EST.

Name: Rita Baker, Contract Specialist E-mail address: rita.baker@irs.gov Fax Number: (240) 613-8559 This survey pertains to: Criminal Investigative (CI) Medical Services for Internal Revenue Service on a nationwide basis.

Solicitation Number: TIRNO-13-R-00032 Date of Survey:

Contractor Name & Address:

Contract Number:

Contract Type (e.g. labor hour):

Contract Dollar Value:

Contract Period of Performance:

General description of products/services required under the contract:

Contracting Role:

FORMCHECKBOX

Prime or FORMCHECKBOX Subcontractor

Termination History:

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Convenience FORMCHECKBOX Default FORMCHECKBOX N/A

Name of Person Completing Survey

Your Company/Agency

Your Role in this Contract

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support very high or very low rating should be noted. Ratings are defined at the end of the survey.

Assign each area a rating of: 4 (Outstanding), 3 (Good), 2 (Acceptable), or 1 (Unsatisfactory). Use the attached Rating Guidelines as guidance in making these evaluations. Double-click the box to insert an “x” for the appropriate rating.

QUALITY OF SERVICE

1. To what degree did this Contractor conform to your contract’s requirements?

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4 3 2 1 N/A

2. To what extent did the contractor respond to and attempt to correct any concerns, issues, or problems that arose during performance of your contract?

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4 3 2 1 N/A

3. How would you rate the effectiveness of the contractor’s problem resolution efforts?

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4 3 2 1 N/A

4. How would you rate the ability of the contractor to provide personnel with the requisite qualifications to accomplish contract/task order requirements?

FORMCHECKBOX

4 3 2 1 N/A

5. How would you rate the Contractor in regards to compliance with Privacy Act and Security requirements if applicable to your project?

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4 3 2 1 N/A

TIMELINESS OF PERFORMANCE

6. To what extent did the Contractor adhere to the overall schedule of your contract?

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4 3 2 1 N/A

7. How would you rate the contractor’s timeliness in providing prompt medical services?

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4 3 2 1 N/A

8. How would you rate the Contractor’s timeliness in providing periodic status reports?

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TECHNICAL PERFORMANCE

9. How reliable was the Contractor?

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4 3 2 1 N/A

10. Was the Contractor responsive to adding additional tests and/or physicals?

FORMCHECKBOX

4 3 2 1 N/A

11. Was the Contractor’s quality control program adequate and did it adhere to contract quality assurance requirements?

FORMCHECKBOX

CONTRACT MANAGEMENT

12. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

FORMCHECKBOX

4 3 2 1 N/A

13. How would you rate the Contractor in understanding/complying with customer objectives and technical requirements?

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4 3 2 1 N/A

14. How would you rate the Contractor in implementing contract requirements?

FORMCHECKBOX

CUSTOMER SATISFACTION

15. How would you rate the Contractor’s commitment to customer satisfaction in terms of their Medical Personnel?

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4 3 2 1 N/A

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

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4 3 2 1 N/A

Please provide any additional comments concerning this contractor’s performance, as desired.

FORMCHECKBOX

File details come from the government source that posted it. Updated Nov 14, 2017.