Attachment_III-Past_Performance_Questionaire.doc
DOC document 77 KB Posted
- Attached to
- Radiological Sample Analysis Federal contract opportunity
- Solicitation number
- W81XWH-16-R-0058
- Issued by
- Department of the Army Medical Command
About this file
Attachment III- Past Performance Questionaire
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment_01-W81XWH-16-R-0058-0001.docx | DOCX document | |
| Attachment_I-SCHEDULE_of_SERVICES_V4.xlsx | XLSX spreadsheet | |
| Attachment_IV-_Tables_from_QSM.pdf | ||
| Attachment_II-Quality_Assurance_Surveillance_Plan.docx | DOCX document | |
| Solicitation-W81XWH-16-R-0058.docx | DOCX document |
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Text version
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 a Request for Proposal for Radiological Sample Analysis. 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 Specialists listed at the bottom right corner of the questionnaire. Do not forward this document to any other point of contact.
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:
FORMCHECKBOX
FIXED PRICE
FORMCHECKBOX
COST + FEE
FORMCHECKBOX
COMPETITIVE
FORMCHECKBOX
NON-COMPETITIVE FORMCHECKBOX
SET-ASIDE
FORMCHECKBOX
SEALED BID
FORMCHECKBOX
NEGOTIATED
CONTRACT NUMBER:
CONTRACT VALUE (INCLUDING OPTIONS):
CONTRACT AWARD & COMPETION DATE:
| PAST PERFORMANCE ELEMENT |
| RATING |
| COMMENTS |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| NA |
1.
Contractor demonstrated a thorough understanding of technical requirements of the contract/task.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
2.
Contractor anticipated/identified and resolved problems effectively.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
3.
Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
4.
Contractor provided the necessary skilled personnel to perform the required work.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
5.
Contractor retained the necessary skilled personnel and maintained a low turnover rate.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
6.
Contractor met scheduled contract delivery dates.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
7.
Contractor provided accurate, complete and high quality deliverables.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
8.
Contractor complied with the terms of the contract.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
9.
Contractor was diligent in forecasting and controlling contract cost.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
| 10. I would hire this contractor again. |
| FORMCHECKBOX |
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
| 1 |
| 0 – 25% of the time |
| Strongly Disagree |
| PLEASE RETURN COMPLETED RESPONSE TO: |
U.S. Army Medical Research Acquisition Activity
ATTN: MCMR-AAA-SB/ Jennifer E. Tait
820 Chandler Street
Fort Detrick, MD 21702-5014
E-MAIL: jennifer.e.tait.civ@mail.mil 301.619.2190
| 2 |
| 26 – 40% of the time |
| Disagree |
| 3 |
| 41 – 55% of the time |
| Somewhat Disagree |
| 4 |
| 56 – 70% of the time |
| Somewhat Agree |
| 5 |
| 71 – 85% of the time |
| Agree |
| 6 |
| 86 – 100% of the time |
| Strongly Agree |
NA
No Knowledge of This Element
USAMRAA Form 74-R, Nov04
FOR OFFICIAL USE ONLY – SOURCE SELECTION SENSITIVE WHEN COMPLETED
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