W81XWH-17-R-0009_Exhibit_B_Past_Performance_Questionnaire_without_ARL_07-07-2017.pdf

DEPARTMENT OF THE ARMY

US ARMY MEDICAL RESEARCH ACQUISITION ACTIVITY

820 CHANDLER STREET

FORT DETRICK MD 21702-5014

MCMR-AAA-MA

Materiel Group - 1 7 July 2017

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number W81XWH-

17-R-0009

Dear Sir/Ma'am;

The U.S. Army Medical Research Acquisition Activity (USAMRAA) is currently conducting a competitive source selection to evaluate Offeror's on the 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) 3391113—Surgical

Appliance and Supplies Manufacturing.

Your assessment of their performance is extremely valuable to our evaluation. Please complete the enclosure and return to the Contract Specialist, Ms. Maribel Fratina via e-mail at maribel.c.fratina.civ@mail.mil, no later than

15 days after receipt of request or by Monday, 7 August 2017, whichever occurs first.

Your cooperation is greatly appreciated. Please direct any questions to Ms. Fratina at 301-619-7731.

Sincerely, EVELYN K. STEPHENSON

Contracting Officer mailto:maribel.c.fratina.civ@mail.mil

Past Performance Evaluation - Questionnaire Form

Contractor: _________________________ Contract No.: _______________________________________

Subcontract No. (if applicable): _________________________

POC: ______________________________ Title: _____________________________________________

(Name) (e.g. Contracting Officer/ACO/TM)

(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.

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.

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:

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 Management (to include use and control of subcontractors)

Acceptable

C. Timeliness of Performance for Services and Product Deliverables

Acceptable

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

Type Contracts Only

Acceptable

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

Acceptable

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:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contract Specialist, Maribel Fratina via e-mail at maribel.c.fratina.civ@mail.mil.

Thank you for your assistance.

EVELYN K. STEPHENSON

Contracting Officer mailto:maribel.c.fratina.civ@mail.mil