A07-Attachment_19_Past_Performance_Evaluation_Questionnaire_Form_A1.docx
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- Solicitation number
- W81XWH-16-R-0019
- Issued by
-
Department of the Army Medical Command
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Attachment 19 Past Performance Evaluation Questionnaire Form
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Attachment 19
PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM
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 solicitation # W81XWH-16-R-0019. 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 e-mail your response to the Contract Specialist whose number and address is shown at the bottom right corner of the questionnaire. Please use the following format for the email subject line “W81XWH-16-R-0019 Offeror Name Performance Questionnaire”. |
Thank you for your time and participation.
PAST PERFORMANCE QUESTIONNAIRE
YOUR NAME & TITLE
YOUR ORGANIZATIONAL ADDRESS
TEL NO.
FAX :
E-MAIL:
CONTRACTOR’S NAME & ADDRESS
TITLE OR DESCRIPTION OF REQUIREMENT:
CONTRACT NUMBER:
CONTRACT VALUE (INCLUDING OPTIONS):
CONTRACT TYPE:
|_| FIXED PRICE |_| COST + FEE |_| COMPETITIVE
|_| NON-COMPETITIVE |_| SET-ASIDE |_| SEALED BID |_| NEGOTIATED
CONTRACT AWARD & COMPLETION DATE:
| PAST PERFORMANCE ELEMENT |
| RATING |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| NA |
| 1. | Contractor demonstrated a thorough understanding of technical requirements of the contract/task. |
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Comments:
| 2. | Contractor anticipated/identified and resolved problems effectively. |
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Comments:
| 3. | Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively. |
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Comments:
| 4. | Contractor provided the necessary skilled personnel to perform the required work. |
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Comments:
| 5. | Contractor retained the necessary skilled personnel and maintained a low turnover rate. |
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Comments:
| 6. | Contractor met scheduled contract delivery dates. |
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Comments:
| 7. | Contractor provided accurate, complete and high quality deliverables. |
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Comments:
| 8. | Contractor complied with the terms of the contract. |
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Comments:
| 9. | Contractor was diligent in forecasting and controlling contract cost. |
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Comments:
| 10. I would recommend award to this contractor again. |
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Comments:
| 1 |
| Outstanding (Explanation must be provided in comments above) |
| PLEASE RETURN COMPLETED RESPONSE TO: |
U.S. Army Medical Research Acquisition Activity Contract Specialist: Andrew Green E-MAIL: Andrew.W.Green17.civ@mail.mil Phone: 301-319-9279
| 2 |
| Good |
| 3 |
| Acceptable |
| 4 |
| Marginal (Explanation must be provided in comments above) |
| 5 |
| Unacceptable (Explanation must be provided in comments above) |
| NA |
| No Knowledge of This Element |
Adjectival ratings definitions to be used in your response:
Outstanding: 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.
Good: 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.
Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.
Marginal: 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.
Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective
No Knowledge of This Element: No knowledge of this element or does not apply to meeting contractual requirements
SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104
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