Attachment 3: MACC PAST PERFORMANCE QUESTIONNAIRE for Offeror

ATTACHMENT #3

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Your organization has been identified for participation in past performance evaluation on a current solicitation at the National Institutes of Health (NIH) at Bethesda, Maryland. This information contained in this questionnaire will be used to evaluate the past performance for the contractor and contracting action identified below.

Request for Proposal NIH

Your candid response to the questions is important to our evaluation effort and may affect the award outcome. Please indicate "Unknown" in any area that was not applicable to work performed on your contracting action.

THE COMPLETED FORM MUST BE SUBMITTED BY E-MAIL TO THE FOLLOWING ADDRESS:

ATTN: Clarion Miller
Contracting Officer (CO)
National Institutes of Health
Building 13, Room 2E48
9000 Rockville Pike,
Bethesda, Maryland 20892-5711

Phone:
301-451-8464

E-mail:
[email protected]

If you have any questions/ concerns pertaining to this survey and/or the requested information please contact Clarion Miller and Magan Miller, Contracting Officers, using the above contact information.

Thank you for your time and effort in completing this survey.

PAST PERFORMANCE QUESTIONNAIRE for offering Contractor

PART I – TO BE COMPLETED BY CONTRACTOR

Item
Requested Information
Information Provided by Contractor
A
Contractor Information

Contractor Company Name

Contractor Representative Name

Title

Address

Telephone

Fax

E-mail Address

Contract Number

Task Order Number

Title of Contract

B
Owner Information

Owner/Company/
Organization/Agency Name

Owner Representative Name

Title

Address

Telephone

Fax

E-mail Address

PAST PERFORMANCE QUESTIONNAIRE

PART II – TO BE COMPLETED BY CONTRACTOR’S REFERENCE

DEFINITIONS

Please use the following definitions when completing the Past Performance Questionnaire: Rating
Description
Exceptional
Performance meets contractual requirements and exceeds many to the Clients benefit. The contractual performance of the element was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. Very Good
Performance meets contractual requirements and exceeds some to the Clients benefit. The contractual performance of the element was accomplished with some minor problems for which corrective actions taken by the contractor was effective. Satisfactory
Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.