Attachment_2_Past_Performance_Package_W912L8-18-R-0009.doc

Past Performance Reference Package Part-time Dentist Support Services

W912L8-18-R-0009

PACKAGE INFORMATION AND FORMS

Instructions to Offeror for sending Reference Questionnaire Forms: Prepare and send a reference questionnaire package to a maximum of 3 of your current or former clients discussed in your past performance proposal. For Government contracts, send to the Contracting Officer or Contract Administrator. For commercial references, send to personnel with duties similar to those for Government contracts. It is your responsibility to follow-up and to encourage your references to send in their questionnaire. If you have multiple references at one location (Base, etc.), send one cover letter and one questionnaire and list the contracts/orders you are asking references for. Each client should not be sent more than one reference package and may combine answers for more than one contract, if applicable. Your questionnaire package should contain the following.

Cover Letter (See SAMPLE Next Page)

Respondent Info Rating Sheets -Offeror should put name in spaces indicated and ensure it is on every page for identification purposes

Suggested – Pre-addressed stamped envelope to return to Contracting Officer.

OFFEROR SHOULD DELETE THE INSTRUCTION PAGE ABOVE BEFORE SENDING OUT

SAMPLE TRANSMITTAL LETTER

(Sample Cover Letter)

Offeror Company Letterhead

Date: _________________

To: ______________________________________

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm has submitted a proposal under a project advertised by the USPFO for West Virginia Contracting Division, Buckhannon WV. In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance. Your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible. Space is provided for comments. Understand that while the responses to this questionnaire may be released to the Offeror, FAR 15.306 (e) (4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address to arrive not later than August 6, 2018 by 3:00 P.M. Do not return them to our company.

USPFO for West Virginia, Contracting Division, 50 Armory Road, Buckhannon, WV 26201. Reference packages may also be faxed to (304) 473-5262 or Email to erica.d.oldaker.civ@mail.mil Email is preferred.

If you have questions regarding the attached questionnaire (or require assistance), please contact Erica Oldaker at (304) 473-5265 or via Email at erica.d.oldaker.civ@mail.mil

Thank you for your assistance.

Signature

Title

***When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly. ***

PAST PERFORMANCE QUESTIONNAIRE

1. The individual knowledgeable of the Contractor’s day-to-day operations and overall condition of services being rendered should complete the survey. However, that individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others in their organization, as applicable.

2. Handwritten responses are acceptable. If response is handwritten, please print legibly.

3. The following qualitative description shall be used as guidance in providing element ratings (assessments should reflect only contract liable performance).

PAST/PRESENT PERFORMANCE RATINGS ARE:

VERY GOOD

· Performance exceeded contractual requirements and exceeded the Government’s benefit. The contractual performance was accomplished with minor problems for which corrective actions taken by the Contractor were effective.

SATISFACTORY

· Performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Contractor were satisfactory.

UNKNOWN

· Little or no recent relevant contract performance

MARGINAL

· Performance did not meet some contractual requirements. The contractual performance reflected a serious problem for which the Contractor did not identify corrective actions. The Contractor’s actions were only marginally effective or were not fully implemented.

UNSATISFACTORY

· Performance did not meet most contractual requirements. The Contractor performance had serious problems for which the Contractor’s corrective actions were ineffective.

4.

For any Marginal/Unsatisfactory, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. Space for narrative comments is included on the last page of the survey. If more space is needed, use the back of the survey or attach additional pages.

5. As this survey relates to an ongoing source selection for the services identified in the cover letter, request that all information provided within the survey be safeguarded against unauthorized disclosure. In accordance with Source Selection procedures, identity of persons providing past performance information will be kept confidential and is not releasable.

6.

Your time and effort in providing this vital and important information is greatly appreciated.

7.

Please mark the completed questionnaire with Solicitation No. W912L8-18-R-0009 and return to:

USPFO for West Virginia

Contracting Division

Attn: Erica Oldaker

50 Armory Road

Buckhannon, WV 26201

NOTE: A Fax or electronic response is acceptable and is the desired method of return.

Please call before faxing.

Fax: 304-473-5262 DSN: 623-5265 Email: erica.d.oldaker.civ@mail.mil ***When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly. ***

SOLICITATION W912L8-18-R-0009

RESPONDENT IDENTIFICATION AND RATINGS

(Part 1 Contractor submitting Proposal fill-in)

Reference is provided for: _______________________________________________________

Contract Number or Project Title_________________________________________________________________________

Date of Award/ Performance Period________________________________________________________________________

Location______________________________________________________________________ Dollar Amount (including modifications) _____________________________________________________________________________ Brief description of work and your role in the referenced contract: ______________________________________________________________________________ (Part 2 Person providing Reference) Reference is provided by: _________________________ Company/Agency: ______________________________________________________________________________

Business Address: ______________________________________________________________________________

Telephone Number: ______________________________________________________________________________

E-Mail Address: ______________________________________________________________________________ Relationship to Contract: ______________________________________________________________________________

If information above (Part 1) is not accurate please indicate.

C. SPECIFIC QUESTIONS: Please answer the following questions in accordance with the qualitative description specified in paragraph 3 above and on a YES/NO basis. When responding to the rating type questions, choose the narrative option which most accurately describes the Contractor’s performance or situation. If the question is not applicable, check “Unknown”. Any Marginal or Unsatisfactory ratings should be supplemented with an explanatory narrative in the remarks block of this survey.

The ratings correspond with the following qualitative values:

A. CUSTOMER SATISFACTION

Very

Good

1. Rate the Contractor’s overall performance and level of customer satisfaction.

2. The Contractor is flexible in satisfying the requirements of the customer.

3. Contractor’s responsiveness/timeliness relative to settling of customer complaints.

4. Contractor displays positive behavior when resolving customer complaints.

5. Contractor receives significant positive feedback?

B. QUALITY OF SERVICE

Very

Good

1. The Contractor develops a quality control plan that adequately ensures conformance to contract requirements.

2. The Contractor performs quality inspections and documents findings to ensure repeat failures don’t occur.

3. The Contractor corrects errors through re-performance and puts policies in place to avoid reoccurrence.

4. A Cure Notice or Show Cause Notice been issued? (If yes, please explain in Remarks section.)

YES _____

NO _____

5. The Contractor displays initiative to implement solutions.

C. TIMELINESS OF PERFORMANCE

Very

Good

1. The Contractor is in compliance with contract requirements regarding time sensitive tasks.

2. The Contractor ensures customer satisfaction through efficient services.

3. The Contractor submits accurate reports in a timely manner.

D. MANAGEMENT EFFECTIVENESS

Very

Good

1. Contract management is experienced with technical and administrative abilities needed to meet contractual requirements.

2. Supervisors and staff meet technical qualifications and have experience necessary to meet contract requirements.

3. The Contractor develops quality business relationships with government customers.

4. Staffing is adequate to meet contract requirements.

5. Contractor complies with the requirements of the statement of work, resulting in low incidence of deficiencies.

E. COST CONTROL

Very

Good

1. Contractor meets the terms of the contract within the contractually agreed price.

2. Modifications were priced within reason as compared to the Government estimate.

3. Modifications require extensive negotiations.

(If yes, please add comments in Remarks section.)

YES _____

F. COMPLIANCE WITH SMALL BUSINESS CONCERNS

Contractor has complied with the utilization of Small Business Concerns?

Any contractor receiving a contract for more than the simplified acquisition threshold must agree in the contract that small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns will have the maximum practicable opportunity to participate in contract performance consistent with its efficient performance.

YES _____

N/A _____

REMARKS: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ (Your) Name: __________________________________________________________________

Contractor Name for Identification: _________________________________________________ Date: _________________________________________________________________________