A03_Attachment_7-_Part_2_Past_Performance_Questionnaire.doc
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- Attached to
- Specimen Shipping and Supply Management
- Solicitation number
- W81XWH-18-R-0050
- Issued by
-
Department of the Army Medical Command
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A03 Attachment 7- Part 2 Past Performance Questionnaire
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| A07_Combined_Synopis_W81XWH-18-R-0050.docx | DOCX document | |
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Text version
U.S. Army Medical Research Acquisition Activity Attachment 7
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-0050, Walter Reed Army Institute of Research (WRAIR) Human Immunodeficiency Virus (HIV) Diagnostics and Reference Laboratory (HDRL) Specimen Shipping and Supply Management for Continental U.S. (CONUS) and Outside Continental U.S. (OCONUS) Sites. 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.
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.
The Contractor demonstrated a thorough understanding of requirements of the contract.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
2.
The Contractor identified and resolved problems effectively.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
3.
The Contractor provided the necessary skilled personnel to perform the required work.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
| 4. The Contractor met scheduled contract delivery dates. |
| FORMCHECKBOX |
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
5.
The Contractor complied with the terms of the contract.
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
FORMCHECKBOX
| 6. 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-SA/ Flodean P. Billings (W81XWH-18-R-0050)
1504B Porter Street
Fort Detrick, MD 21702-5014
E-MAIL: flodean.p.billings.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
USAMRAA Form 74-R
FOR OFFICIAL USE ONLY – SOURCE SELECTION SENSITIVE WHEN COMPLETED
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