Exhibit_D_-_Past_Performance.pdf

DEPARTMENT OF THE ARMY

U.S. ARMY MEDICAL RESEARCH ACQUISITION ACTIVITY

820 CHANDLER STREET

FORT DETRICK, MD 21702-5014

Service Branch 1

SUBJECT: Offeror Past Performance

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number W81XWH-18-R-0027.

Dear Sir/Ma'am;

The US Army Medical Research Acquisition Activity (USAMRAA) is currently conducting a competitive source selection to evaluate offeror's on 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) 541715. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to USAMRAA, ATTN: Mr. Sharew Hailu, Contract Specialist, 1504B Porter Street, Fort Detrick, MD 21702-5014, by proposal due date.

Your questionnaire may be submitted electronically to Mr. Sharew Hailu at e-mail:

sharew.hailu.civ@mail.mil.

Your cooperation is greatly appreciated.

Please direct any questions to Mr. Sharew Hailu at (301) 619-9201.

Sincerely, Jennifer Jackson Contracting Officer

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: ___________________ Contract No: ___________________ Subcontract No. (if applicable): ___________________ POC: ___________________ Title: ___________________

(Name) (e.g. PCO/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 N a m e /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:

Address:

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. Timeliness of Performance for Services and Product Deliverables

□ Acceptable

□ Marginal (Explanation must be provided in Comments field below)

□ Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

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

□ Acceptable

□ Marginal (Explanation must be provided in Comments field below)

□ Unsatisfactory (Explanation must be provided in Comments field below) Comments:

D. General Comments. Provide any other relevant performance information.

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:

E. Respondent Identification. Please provide the following information:

Organization:

Name: Title: Date:

Telephone Number: Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to Mr. Sharew Hailu, Contract Specialist, at sharew.hailu.civ@mail.mil.

Thank you for your assistance.

Signature Date

Typed or Printed Name

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 the W81XWH-18-R-0027. 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.

Thank you for your time and participation.

1 0 – 25% of the

Strongly Disagree PLEASE RETURN COMPLETED RESPONSE TO:

U.S. Army Medical Research Acquisition Activity

FAX: (301) 619-9201

ATTN: MCMR-AAA-SA/ Sharew Hailu (W81XWH-18-R-0027) 1504B Porter Street Fort Detrick, MD 21702-5014 E-MAIL: sharew.hailu.civ@mail.mil.

2 26 – 40% of

Disagree 3 41 – 55% of

Somewhat Disagree

4 56 – 70% of

Somewhat Agree 5 71 – 85% of

Agree

6 86 – 100% of

Strongly Agree N A No Knowledge of

This Element

YOUR NAME & TITLE

YOUR ORGANIZATIONAL

ADDRESS

TEL NO. FAX:

E MAIL: CONTRACTOR’S NAME &

ADDRESS

TITLE OR DESCRIPTON OF

REQUIREMENT:

CONTRACT TYPE: FIXED

PRICE COST + FEE

COMPETITIVE NON-

CONTRACT NUMBER:

CONTRACT VALUE

(INCLUDING OPTIONS):

CONTRACT AWARD &

COMPETION DATE:

PAST PERFORMANCE

ELEMENT

RATING COMMENTS 1 2 3 4 5 6 N

1. The Contractor demonstrated a thorough

2. The Contractor identified and resolved problems

3. The Contractor provided the necessary skilled personnel to

4. The Contractor met scheduled contract delivery dates.

5. The Contractor complied with the terms of the contract.

6. I would hire this Contractor again.

PART I. (To be completed by the Offeror)