ATCH.3.PPQ.docx

Department of the Army

US ARMY MEDICAL RESEARCH ACQUISITION ACTIVITY

820 CHANDLER STREET

FORT DETRICK MD 21702-5014

ATTACHMENT 3

Service Branch - 1 12 July 2016

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number W81XWH-16-R-0014, Software Scripting Associated with COTS Body Sensors

Dear Sir/Ma'am;

The US Army Medical Research Acquisition Activity (USAMRAA) is currently conducting a competitive source selection to evaluate offeror's on subject RFP. As part of this evaluation, we have requested that offeror's provide information about their past performance on same or similar federal, state or local government or commercial contracts as compared to North American Industry Classification System (NAICS) 541712. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to USAMRAA, ATTN: Mrs. Donna Blackstone, 820 Chandler Street, Fort Detrick, MD 21702-5014, no later than 15 days after receipt of request or by Tuesday, August 16, 2016, whichever occurs first. Your questionnaire may be submitted electronically to Mrs. Donna Blackstone, Contract Specialist, at e-mail: donna.r.blackstone.civ@mail.mil.

Your cooperation is greatly appreciated.

Please direct any questions to Mrs. Blackstone at 301-619-2276.

Sincerely,

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: _________________________ Contract No.: ________________________

Subcontract No. (if applicable): _________________________

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor's record of past (within the past three years) and current performance. The information that you provide will be used in awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

PAST PERFORMANCE RELEVANCE RATINGS

Very Relevant - Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.

Relevant - Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

Somewhat Relevant - Present/past performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.

Not Relevant - Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires.

PERFORMANCE CONFIDENCE ASSESSMENTS

Substantial Confidence - Based on the offeror's recent/relevant performance record, the Government has a high expectation that the Offeror will successfully perform the required effort.

Satisfactory Confidence - Based on the offeror's recent/relevant performance record, the Government has a reasonable expectation that the Offeror will successfully perform the required effort.

Limited Confidence - Based on the offeror's recent/relevant performance record, the Government has no expectation that the Offeror will be able to successfully perform the required effort.

Unknown Confidence (Neutral) - No recent/relevant performance record is available or the offeror's performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

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 name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR'S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact - Respondent)

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

B. Effectiveness of Project Management (to include use and control of subcontractors)

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

C. Timeliness of Performance for Services and Product Deliverables

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

Comments:

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers' Interest

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

F. General Comments. Provide any other relevant performance information.

G. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to Mrs. Donna Blackstone, Contract Specialist, at donna.r.blackstone.civ@mail.mil.

Thank you for your assistance.

JENNIFER C. JACKSON

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