Past_Performance_Questionnaire_18-R-0007.doc

DOC document 129 KB Posted Dec 7, 2017

Attached to: epidemiological, statistical, and limited administrative support for AMSARA, funded projects of the Department of Epidemiology, and WRAIR researchers
Solicitation number: W81XWH-18-R-0007
Issued by: Department of the Army Medical Command

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Past performance questionaire

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Department of the Army

US ARMY MEDICAL RESEARCH ACQUISITION ACTIVITY

820 CHANDLER STREET

FORT DETRICK MD 21702-5014

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-18-R-0007 for Non-persoanl services epidemiological, statistical, and limited administrative support for AMSARA, funded projects of the Department of Epidemiology, and WRAIR researchers at the Walter Reed Army Institute of Research (WRAR). The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s).

Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone and fax number.

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.

Use the rating scale found on the bottom left corner of the questionnaire to rate each performance element.

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.

Please e-mail your response to the Contract Specialist whose number and address is shown at the bottom right corner of the questionnaire.

Thank you for your time and participation.

FOR OFFICIAL USE ONLY - SOURCE SELECTION SENSITIVE WHEN COMPLETED

USAMRAA Form 74-R-E (FEB 2007)

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:

FORMCHECKBOX

FIXED PRICE

FORMCHECKBOX

COST + FEE

FORMCHECKBOX

COMPETITIVE

FORMCHECKBOX

NON-COMPETITIVE

FORMCHECKBOX

SET-ASIDE

FORMCHECKBOX

SEALED BID

FORMCHECKBOX

NEGOTIATED

FORMCHECKBOX

SEALED BID

FORMCHECKBOX

NEGOTIATED

CONTRACT AWARD & COMPLETION DATE:

PAST PERFORMANCE ELEMENT

RATING

Contractor demonstrated a thorough understanding of technical requirements of the contract/task.

FORMCHECKBOX

Comments:

Contractor anticipated/identified and resolved problems effectively.

FORMCHECKBOX

Comments:

Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.

FORMCHECKBOX

Comments:

Contractor provided the necessary skilled personnel to perform the required work.

FORMCHECKBOX

Comments:

Contractor retained the necessary skilled personnel and maintained a low turnover rate.

FORMCHECKBOX

Comments:

FOR OFFICIAL USE ONLY - SOURCE SELECTION SENSITIVE WHEN COMPLETED

USAMRAA Form 74-R-E (FEB 2007)

PAST PERFORMANCE QUESTIONNAIRE

Contractor met scheduled contract delivery dates.

FORMCHECKBOX

Comments:

Contractor provided accurate, complete and high quality deliverables.

FORMCHECKBOX

Comments:

Contractor complied with the terms of the contract.

FORMCHECKBOX

Comments:

Contractor was diligent in forecasting and controlling contract cost.

FORMCHECKBOX

Comments:

10. I would recommend award to this contractor again.

FORMCHECKBOX

Comments:

0 – 25% of the time

Strongly Disagree

PLEASE RETURN COMPLETED RESPONSE TO:

U.S. Army Medical Research Acquisition Activity

ATTN: MCMR-AAA-S1/John Fitzsimmons

820 Chandler Street

Fort Detrick, MD 21702-5014

E-MAIL: john.l.fitzsimmons8.civ@mail.mil 6194084-

26 – 40% of the time

Disagree

41 – 55% of the time

Somewhat Disagree

56 – 70% of the time

Somewhat Agree

71 – 85% of the time

Agree

86 – 100% of the time

Strongly Agree

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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