Past_Performance_Survey_for_W81XWH13R0009.doc

U.S. Army Medical Research Acquisition Activity Attachment 1

Attachment 1

PAST PERFORMANCE QUESTIONNAIRE

AND INSTRUCTIONS

PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

U.S. ARMY MEDICAL RESEARCH ACQUISITION ACTIVITY

Fort Detrick, MD

The information obtained from this questionnaire will be utilized to evaluate the past and present performance of offerors submitting proposals in response to the W81XWH-13-R-0009. The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s).

a.

Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone and fax number.

b.

Include the contractor’s name and address, the title and/or description of the type of work performed, the award number, the value of the contract (including options), the award and completion date of the project and the type of award/solicitation.

c.

Use the rating scale found on the bottom left corner of the questionnaire to rate each performance element.

d.

Comments are encouraged and would be appreciated. The last page may be used if additional space is needed for comments.

Clear handwritten responses are sufficient.

e.

Please FAX or e-mail your response to the Contract Specialist whose number and address is shown at the bottom right corner of the questionnaire.

Thank you for your time and participation.

Your Name & Title yOUR Organizational Address

TEL NO.

FAX:

E-MAIL:

CONTRACTOR’S NAME & ADDRESS

TITLE OR DESCRIPTON OF REQUIREMENT:

CONTRACT TYPE:

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FIXED PRICE

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COST + FEE

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COMPETITIVE

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SET-ASIDE

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SEALED BID

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NEGOTIATED

CONTRACT NUMBER:

CONTRACT VALUE (INCLUDING OPTIONS):

CONTRACT AWARD & COMPETION DATE:

1.

Contractor demonstrated a thorough understanding of technical requirements of the contract/task.

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2.

Contractor anticipated/identified and resolved problems effectively.

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3.

Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.

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4.

Contractor provided the necessary skilled personnel to perform the required work.

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5.

Contractor retained the necessary skilled personnel and maintained a low turnover rate.

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6.

Contractor met scheduled contract delivery dates.

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7.

Contractor provided accurate, complete and high quality deliverables.

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8.

Contractor complied with the terms of the contract.

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9.

Contractor was diligent in forecasting and controlling contract cost.

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U.S. Army Medical Research Acquisition Activity

FAX: 301-619-3002

ATTN: MCMR-AAA-W/ Monica J. Pileggi (W81XWH-13-R-0009)

820 Chandler Street

Fort Detrick, MD 21702-5014

E-MAIL: monica.pileggi@us.army.mil

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No Knowledge of This Element

USAMRAA Form 74-R, Nov04

FOR OFFICIAL USE ONLY – SOURCE SELECTION SENSITIVE WHEN COMPLETED