Request for Proposals Attachment 14 Past Perfomance Questionnaire Template

ATTACHMENT #14

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE – APPLY TO PRIME OFFEROR:

Your assistance is requested in support of a source selection. Request a representative of the contracting organization and a technical representative, the Program Manager (PM), and the Contracting Officer’s Representative (COR), complete this questionnaire and e-mail to:

HHS/OS/ASPR/CMA

Attn: Laura Saddison, Contracting Officer [email protected]

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

BLOCKS 1 THROUGH 8 TO BE COMPLETED BY THE OFFEROR

OFFEROR NAME & ADDRESS:

2. CONTRACT NO.:

3. CONTRACT AWARD DATE:

4. PERIOD OF PERFORMANCE/COMPLETION DATE:

5. Approximate percentage of work being performed (or completed) by subcontractor(s):%

6. Information on subcontractor(s) (where more than % of work was completed by the subcontractor).

7. CONTRACT VALUE (WITH OPTIONS):

8. TYPE OF CONTRACT:

9. TITLE OF CONTRACT AND DESCRIPTION OF CONTRACT REQUIREMENTS:

BLOCKS 9 THROUGH 10F TO BE COMPLETED BY EVALUATION ORGANIZATION REPRESENTATIVE

10.EVALUATION:

EVALUATOR’S NAME

POSITION (PCO/PM/COR/OTHER)

ORGANIZATION

PHONE NUMBER/E-MAIL

b. MONTHS OFFEROR PERFORMANCE MONITORED BY EVALUATOR:

c. RATINGS - Please check the block beside the response code that best reflects your evaluation of the Offeror’s performance.

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support rating may be noted at the end of the questionnaire under ‘additional comments’.

Assign each area a rating of 0 (Unsatisfactory), 1 (Marginal), 2 (Satisfactory), 3 (Very Good), 4 (Exceptional) or 5 (Outstanding). Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the Offeror to make a determination on any of the performance criteria below, please circle “N/A” (not applicable /no opinion).

A. Quality of Product or Service

A-1. Compliance with contract requirements
N/A

A-2. Accuracy of reports
N/A

A-3. Effectiveness of personnel
N/A

A-4. Technical excellence
N/A

B. Cost Control

B-1. Record of forecasting and controlling target costs N/A

B-2. Current accurate and complete billings
N/A

B-3. Best value (balance of performance vs. cost).
N/A

B-4. Relationship of negotiated costs to actuals