RFP ATTACHMENT 6 - PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE.pdf

ATTACHMENT 6 - PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does and/or notify the Contracting Officer. Please return the completed Questionnaire.

Submit your completed questionnaire to Nathaniel Trulove, nathaniel.w.trulove.civ@health.mil, Carlos Ramirez, carlos.a.ramirez18.civ@health.mil, and David Robledo, david.robledo17.civ@health.mil within the stated timeframe.

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements.

Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions, or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To Be Completed By The Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division: _______________________________________ Address: _____________________________________________________________ Program Identification/Title: ______________________________________________ Contract Number: ____________________ Contract Type: ______________________ Prime Contractor Name (if different from the contractor’s name cited above): ___________________________ Contract Award Date: _____________ Forecasted or Actual Contract Completion Date: _____________ Nature of the Contractual Effort or Items Purchased: ___________________________ Total Contract Value: _______________________

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name/Title: ______________________________________ Telephone Number: _______________________________ E-mail Address: ___________________________________

PART II. EVALUATION (To Be Completed By Point of Contact – Respondent) *Note: Rationale Is Required For Each Response

A. Compliance Of Products, Services, Documents, And Related Deliverables To Specification Requirements And Standards Of Good Workmanship

☐ Substantial Confidence ☐ Satisfactory Confidence ☐ Limited Confidence ☐ No Confidence

Rationale:

B. Effectiveness Of Project Management (To Include Use And Control Of Subcontractors).

☐ Limited Confidence

C. Timeliness Of Performance For Services And Product Deliverables.

☐ Limited Confidence

D. Small Business Participation/Subcontracting (Does The Contractor Meet The Small Businesses Goals Relative To Your Contract?)

☐ Limited Confidence

E. Commitment To Customer Satisfaction And Business-Like Concern For Its Customers’ Interest

☐ Limited Confidence

F. General Comments. Provide Any Other Relevant Performance Information.

Comments:

G. Other Information Sources. Please Provide The Following Information:

Are you aware of other relevant past efforts by this company? ☐ Yes ☐ No

If yes, please provide:

Organization: __________________________________________________________ Name/Title: ______________________________________ Telephone Number: _______________________________ E-mail Address: ___________________________________

H. Respondent Identification. Please Provide The Following Information:

Organization: __________________________________________________________ Name/Title: ______________________________________ Telephone Number: _______________________________ E-mail Address: ___________________________________

PART III. RETURN INFORMATION

Please return this completed Questionnaire to Nathaniel Trulove, nathaniel.w.trulove.civ@health.mil, Carlos Ramirez, carlos.a.ramirez18.civ@health.mil, and David Robledo, david.robledo17.civ@health.mil.

Thank you for your assistance.