7.8.16_Exhibit_A_Past_Performance_Questionnaire.docx

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USAMMDA Chemical Patient Protective Wrap (CPPW) Kits
Solicitation number
W81XWH-16-R-0059
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Past Performance Questionaire

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Exhibit A

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 Chemical Patient Protective Wrap solicitation W81XWH-16-R-0059. 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 Shylonda Minter, Contract Specialist, to shylonda.y.minter.civ@mail.mil no later than 1 p.m. on 8 August 2016. Do not send back to the requesting company or individual. If you have any questions, please contact Shylonda Minter via email at the address listed above.

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

|_| SEALED BID |_| NEGOTIATED

CONTRACT AWARD & COMPLETION DATE:

PAST PERFORMANCE ELEMENT
RATING
1
2
3
4
5
6
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 provided the necessary skilled personnel to perform the required work.
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Comments:

4. Contractors training to Government staff on the installed systems operation and function were useful and sufficient.
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Briefly describe type of work performed:

FOR OFFICIAL USE ONLY - SOURCE SELECTION SENSITIVE WHEN COMPLETED

USAMRAA Form 74-R-E (FEB 2007)

PAST PERFORMANCE QUESTIONNAIRE

5. Contractor met scheduled contract delivery dates.
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Comments:

6. Contractor provided accurate, complete and high quality deliverables.
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Comments:

7. Contractor complied with the terms of the contract.
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Comments:

8. I would recommend award to this contractor again.
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Comments:

1
0 – 25% of the time
Strongly Disagree
PLEASE RETURN COMPLETED RESPONSE VIA EMAIL TO:

U.S. Army Medical Research Acquisition Activity

ATTN: MCMR-AAA-MA

820 Chandler Street Fort Detrick, MD 21702-5014 E-MAIL: shylonda.y.minter.civ@mail.mil

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

FOR OFFICIAL USE ONLY - SOURCE SELECTION SENSITIVE WHEN COMPLETED

USAMRAA Form 74-R-E (FEB 2007)

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