Past Performance Questionnaire

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Amendment No. 1, Dated March 12, 2010 to
RFP No. AHRQ-10-10006, issued March 8, 2010

Proposal Due: April 27, 2010, 12 Noon, EST. (unchanged)

The purpose of this amendment is to provide the Correct Past Performance Questionnaire and Contractor Performance Form, attached. The past performance questionnaire provided in the RFP referenced an incorrect RFP number and title. Please use the attached questionnaire to avoid confusion. The attachment is 6 pages. The only change is on the first page.

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Attachment 1

Past Performance Questionnaire

Part One: Instructions

The offeror listed below has submitted a proposal in response to the Agency for Healthcare Research and Quality (AHRQ) Solicitation No. AHRQ-10-10006 entitled "Developing Evidence to Inform Decisions about Effectiveness Research Network-2 (DECIDE-2)." Past performance is an important part of the evaluation criteria for this acquisition, so input from previous customers of the offeror is important. This office would greatly appreciate you taking the time to complete this form. This information is to be provided to Mary Haines, the AHRQ Contracting Officer and is NOT to be disclosed to the offeror either verbally or in writing. Please provide an honest assessment and return to AHRQ to the address shown below, no later than April 27, 2010, 12:00 pm EST. If you have any questions, please contact Ms. Mary Haines at 301-427-1786.

Ms. Mary Haines
Agency for Healthcare Research and Quality
Division of Contracts Management
540 Gaither Road
Rockville, Maryland 20850

Fax: (301) 427-1740

Name of Offeror: _____________________________________

Address: ____________________________________________

              _____________________________________________

              _____________________________________________

Identifying information of Evaluator, please print

Contractor Performance Form

1. Name of Contractor: ______________________________

2. Address: _________________________________________

                 _________________________________________

3. Contract/Grant Number: _______________________________________

4. Contract/Grant Value (Base Plus Options): _________________________

5. Contract/Grant Award Date: ____________________________________

6. Contract/Grant Completion Date: ________________________________

7. Type of Contract/Grant: (Check all that apply) ( )FP ( )FPI ( )FP-EPA ( ) Award Fee ( ) CPFF-Completion ( ) CPFF-Term ( ) CPIF ( ) CPAF ( ) IO/IQ ( ) BOA ( ) Requirements ( ) Labor-Hour ( )T&M ( ) SBSA ( )8(a) ( )SBIR ( ) Sealed Bid( )Negotiated( )Competitive ( )Non-Competitive

8. Description of Requirement:
   
   
   
   
   

Contractor's Performance Rating

Ratings: Summarize contractor performance and circle in the column on the right the number which corresponds to the performance rating for each rating category. Please see reverse page for explanation of rating scale.

Quality of Product or Service	Comments	0 1 2 3 4 5
Cost Control	Comments	0 1 2 3 4 5
Timeliness of Performance	Comments	0 1 2 3 4 5
Business Relations	Comments	0 1 2 3 4 5

Customer Satisfaction - Is/was the Contractor committed to customer satisfaction? ___ Yes ___ No

Would you use this Contractor again? ___ Yes ___ No

Reason:

Name Of Evaluator: _______________________________________

Title Of Evaluator: ________________________________________

Signature Of Evaluator: ___________________________________

Date: _____________________

Mailing Address:
________________________________________________________
________________________________________________________
________________________________________________________

Phone #: __________________________________

Please Print

Rating Guidelines: Summarize contractor performance in each of the rating areas. Assign each area a rating 0 (Unsatisfactory), 1 (Poor), 2 (Fair), 3 (Good), 4 (Excellent) 5 (Outstanding). Use the following instructions as guidance in making these evaluations.

	Quality	Cost Control	Timeliness of Performance	Business Relation
	Compliance with contract requirements Accuracy of reports Technical excellence	Within budget(over/under target costs) Current, accurate, and complete billings Relationship of negotiated costs to actual Cost efficiencies Change orders issue	Met interim milestones Reliable Responsive to technical direction Completed on time, including wrap-up and contract adm No liquidated damages assessed	Effective management Businesslike correspondence Responsive to contract requirements Prompt notification of problems Reasonable/cooperative Flexible Pro-active Effective small/small disadvantaged business sub-contracting program
0-Unsatisfactory	Nonconformances are jeopardizing the achievement of contract requirements, despite use of Agency resources	Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources	Delays are jeopardizing the achievement of contract requirements, despite use of Agency's resources	Response to inquiries, technical/service/administrative issues is not effective
1-Poor	Overall compliance requires major Agency resources to ensure achievement of contract requirements	Ability to manage cost issues requires major Agency resources to ensure achievement of contract requirements	Delays require major Agency resources to ensure achievement of contract requirements	Response to inquiries, technical/service/administrative issues is marginally effective
2-Fair	Overall compliance requires minor Agency resources to ensure achievement of contract requirements	Ability to manage cost issues requires minor Agency resources to ensure achievement of contract requirements	Delays require minor Agency resources to ensure achievement of contract requirements	Response to inquiries, technical/service/administrative issues is somewhat effective
3-Good	Overall compliance does not impact achievement of contract requirements	Management of cost issues does not impact achievement of contract requirements	Delays do not impact achievement of contract requirements	Response to inquiries, technical/service/administrative issues is usually effective
4-Excellent	There are no quality problems	There are no cost management issues	There are no delays	Response to inquiries, technical/service/administrative issues is effective

5-Outstanding. The Contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where Contractor performance clearly exceeds the performance levels described as "Excellent."

Current as of March 15, 2010