EXHIBIT_A_Performance_Relevancy_Questionnaire.doc

MEDICAL CASE MANAGEMENT SERVICES

RFP W91SMC-15-R-0003

EXHIBIT A PERFORMANCE RELEVANCY QUESTIONNAIRE

PART 1: Prepare questionnaires in the format provided.

Provide the following information requested in this format for each of the projects/contracts being described. Prepare not more than five (5) of these documents. Contractors should select their projects carefully because the quality and relevance of the contractor’s performance is more important than the quantity of projects submitted. Projects cannot have been completed any earlier than 5 years prior to the solicitation issue date and may be on going. Provide frank, concise comments regarding your performance on the contracts you identify. Use as much space as required.

A. Offeror (Your) Name (Company/Division):

B. Project/Contract Title:

C. Contract Specifics:

1. Description of Effort as ___________Prime or _________Subcontractor

2. Contract Number _____________________

3. Original Contract $ Value _____________ Current/Final Contract $ Value ____________

4. If amounts in 3 above are different, provide a brief description of the reason:

5. Completion Date:

a. Original Date: ______________

b. Current Schedule____________________

c. Estimate/Final Completion Date:________________________________

d. Primary cause for Contract Modifications__________________________________

D. Provide detailed description of the work performed under the contract including, but not limited to: similarity of size, scope, cost magnitude, location, client type (e.g. federal government) and complexity of work performed.

In addition, address in detail the following: (Use as much space as necessary)

1. Describe the specific elements of the work performed by your firm.

2. Address any technical areas about this project you consider uniquely relevant to this project.

3. If you intend to use any of the same key personnel on this solicitations’ project, indicate by name and position those personnel proposed to be utilized on the referenced contract. (Project/Contract Manager, Event Superintendent, Quality Control Manager, Key Medical/Dental Personnel). Indicate what position they will have on this solicitation’s contract. If you do not intend on utilizing any of these same personnel please so indicate.

E. List a point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number and facsimile number. Email address is also desired. (This information is required here even though you will be sending Exhibit C letters and questionnaires to theses references. (Do NOT include a copy of the Exhibit Cs you sent to your references.)

End of Part 1- Questionnaire Requirements – Prepare and send Exhibit C Package to the reference(s) for each of projects discussed in the Exhibit As.

PART 2: Provide the following information one time.

Additional offeror information required, but not project specific. This information need only be provided once in your submission package.

2 A. Applicable to all offerors - Describe your Compliance with the requirements of FAR clause 52.219-8 Utilization of Small Business Concerns (Deviation). (Even if you are a Small or Small Disadvantaged Business, this clause in Federal Contracts applies.) It is the policy of the United States that small business concerns, veteran-owned small business concerns, service-disabled veteran-owned small business concerns, HUBZone small business concerns, small disadvantaged business concerns, and women-owned small business concerns shall have the maximum practicable opportunity to participate in performing contracts solicited by any Federal agency, including contracts and subcontracts for subsystems, assemblies, components, and related services for major systems. It is also policy to establish procedures to ensure the timely payment of amounts due pursuant to the terms of their subcontracts. Describe below the methods you have used to comply with this policy on prior federal contracts. Include any evidence, or a point of contact to verify this information, if available.

2B: Offerors are strongly encouraged to include with their proposals information on problems encountered on relevant projects and the specific corrective actions taken to remedy the problem(s).

2C: List any projects within the last five (5) years that have been assessed Liquidated damages. If none have been assessed, make a positive statement to that effect.

2D: List any projects within the last five (5) years that have been terminated, for any reason. Provide an explanation. If none, make a positive statement to that effect.

2E: List of Projects requiring familiarization with AR 40-501 Standards of Medical Fitness and/or AR 40-35 Dental Readiness & Community Oral Health Prevention.

2F: Other Past Performance Considerations (OPTIONAL) Information, if provided, shall be limited to the period starting 5 years prior to the solicitation release date.

Effectiveness of value engineering (VEC) proposals you submitted on prior contracts. (Provide a brief description; impact on cost, schedule, efficiency or quality; contract number; name and phone number of customer benefiting from the VEC).

Professional/Industry awards (Identify award type, date of award and copy of certificate if applicable), Letters of appreciation, recognition or commendations.

Discuss unique skills and accomplishments (Explain unique skills and/or accomplishments and provide supporting information for verification).

End of Questionnaire Requirements