APPENDIX_A_-_Past_Performance_Questionaire.doc

APPENDIX A

PAST AND PRESENT PERFORMANCE DATA

COVER SHEET

For Solicitation W9114F-17-R-0001 OCONUS Dental Services Name and address of offeror questionnaire is being completed for:

Name of Company Name of organization completing questionnaire:

Contract Number:

Contract Type (FFP, Cost, etc):

Services Provided:

Contract Amount:

Contract Period of Performance:

Name, title and phone number of person completing questionnaire: _______________________

Length of time your firm has been involved with this company:___________________________

Submit completed Cover Sheet and Survey via facsimile or e-mail to:

REGIONAL HEALTH CONTRACTING OFFICE-EUROPE

Attn: Thelma Walker

Phone: 011-49-6371-9464-5406 e-mail: thelma.d.walker.civ@mail.mil and james.k.butler.civ@mail.mil

CONTRACTOR PERFORMANCE EVALUATION

SURVEY RATING SHEET

For

Solicitation: W9114F-17-R-0001

RATING SCALE

Please use the following ratings to answer the questions. If you are unable to rate an item because it was not a requirement, never an issue, or you have no knowledge of the item in question, then you should mark “N/A”.

EVALUATION CRITERIA

Acceptable: Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

Unacceptable: Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, “unknown” shall be considered “acceptable.”

For statements indicating “Unacceptable”, an explanation in the comments section of the survey must be provided.

CONTRACTOR PERFORMANCE EVALUATION SURVEY

For

Solicitation: W9114F-17-R-0001

Acceptable Unacceptable

A. QUALITY OF PRODUCT OR SERVICE:

(1) The Contractor provided service that conformed to contract requirements, specifications, and standards of good workmanship.

(2) The Contractor submitted accurate reports/credentials packages.

B. COST CONTROL:

(1) The Contractor performed the effort within the estimated cost/price.

(2) The Contractor submitted accurate invoices on a timely basis.

C. TIMELINESS/SCHEDULE:

(1) The tasks required under this effort were performed in a timely manner and in accordance with the period of performance of the contract.

(2) The Contractor was responsive to technical and/or contractual direction.

D. BUSINESS RELATIONSHIPS:

(1) The Contractor demonstrated effective management over the effort performed.

(2) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) was apprised of technical, cost, and schedule issues.

(3) The Contractor presented information and correspondence in a clear, concise, and businesslike manner.

(4) The Contractor promptly notified the COR and/or

Contracting Officer in a timely manner regarding urgent issues.

(5) The Contractor cooperated with the Government in providing flexible, proactive, and effective recommended solutions to critical contract issues.

E. KEY PERSONNEL:

(1) The labor turnover in key personnel labor categories was minimal and did not adversely affect Contractor performance.

(2) The Contractor proposed qualified personnel to fulfill the requirements of the contract.

F. OTHER:

(1) Would you award this firm another contract? ( ) Yes, ( ) No If you answered “No” provide an explanation.

(2) Was the contract terminated for default? ( ) Yes, ( ) No

If you answered “Yes”, provide an explanation.

(3) Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, etc.?

( ) Yes, ( ) No If you answered “Yes”, provide an explanation.

(4) Based upon the information you provided and using the definitions provided in the evaluation criteria above, the overall performance rating you would give this contractor is:

Acceptable______ Unacceptable_____ COMMENTS: (Required for ALL Unacceptable Ratings)