B.08 Past Performance Questionnaire-TPC.docx

PAST PERFORMANCE QUESTIONNAIRE

Medical Readiness Contracting Office-East Third Party Collections Services

W91YTZ23R0001

Please provide your candid responses. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Name of Contractor/Company being evaluated:

Name of Contractor/Company Name/Division providing the evaluation:

Address:

Program/Account Identification/Title:

Contract Number:

Contract Type:

Contract Amount:

Prime Contractor Name (if different from the contractor name cited above):

Period of Performance:

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Detailed description of purchases or services provided;.

Was this work with a: Commercial ____ Fed Gov’t_____ Local/State Gov’t entity._____ Relevance of the referenced contract to the current requirement:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (TO BE COMPLETED BY POINT OF CONTACT –RESPONDENT)

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor’s control). An individual within your organization that is knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor’s performance

Little doubt exists, based on the offeror’s preponderance of good, if not excellent past and current records of contract performance, especially in large contracts similar to the size and complexity of the services under solicitation. Verification of past performance shows that offeror consistently meets work schedules, provides specified services, meets contract terms without failure, and has not been defaulted on any contract within the past three years.

Some doubt exists based on instances of record of poor performance, especially in contracts similar to the size and complexity of the services under solicitation. Verification of past performance shows that offeror meets work schedules and specified services most of the time, meets contract terms without failure or resolves issues immediately, and has not been defaulted on any contract within the past three years.

Significant doubt exists that the offeror will satisfactorily perform the services on solicitation, based on preponderance of unsatisfactory performance records under the various factor evaluations, or Offeror’s record of unsuccessful past and current contracts performance in fulfilling requirements similar to the size and complexity of the services under solicitation. Verification of past performance shows that offeror’s have consistently not met work schedules and other obligations, have defaulted on at least one contract within the past three years, or have chronically failed to meet contract terms.

No relevant past performance information.

When responding to the questions listed, circle the letter that most accurately describes the contractor’s performance or situation. For any low, medium, high or neutral rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, circle N/A. If you circle a Yes/No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly.

Your time and effort in providing this vitally important information are greatly appreciated.

PERFORMANCE ELEMENTS:

QUALITY OF SERVICE

TIMELINESS OF SERVICE

BUSINESS RELATIONS

CONTRACTUAL CONSIDERATIONS

Partially ________ Completely _________

YES* NO

*REMARKS

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:

PART III. RETURN INFORMATION

Please return the completed Questionnaire to: michael.j.mccollum12.civ@health.mil and cheryl.a.ricker2.civ@health.mil.

Thank you for your assistance