Atch 4 PPQ.pdf

Attachment 4, PPQ

FA561322Q0018

Past Performance Questionnaire (PPQ) Pairing Health, Nutrition, and Exercise (PHNX) Program Services compromised of a team of medical providers & supporting agencies aimed to increase preventative fitness capabilities for Airmen assigned to Ramstein Air Base in Germany.

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address:

Telephone Number: ____________________

Email Address: ____________________

Point of Contact: ____________________

Project Title or Brief Description of Work*:

Contract Number*: Contract Amount:

Contract Period or Dates of Performance*:

Contractor performed as the Prime Contractor: YES NO

To be completed by the respondent and returned directly to the contracting office.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RATER INFORMATION:

Name of Rater: __________________________________________

Title: __________________________________________

Address: __________________________________________

Phone Number: __________________________________________

Email Address: __________________________________________

C. RETURN COMPLETED SURVEY FORM NOT LATER THAN 19 NOV 2021 TO:

Rebecca Berry/Contract Specialist Mr. Douglas Lindsey/Contracting Officer

700 CONS/PKA 700 CONS/PKA

rebecca.berry.1@us.af.mil douglas.lindsey@us.af.mil mailto:rebecca.berry.1@us.af.mil mailto:douglas.lindsey@us.af.mil

CONTRACTOR’S NAME: CONTRACT NUMBER:

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements and exceeds many to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements and exceeds some to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements.

The contractual performance of the element or sub-element being assessed contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements and adequate project supervision at the place of performance.

2. Demonstrated ability to hire, maintain, and/or replace, if necessary, qualified personnel during the contract period.

3. Provided adequately trained and certified personnel.

4. Interfaced and cooperated with government quality assurance personnel (or corporate/agency equivalent) after being awarded the contract and/or commencement of project performance.

5. Maintained sanitary conditions within the work environment.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Provided timely resolution of contract discrepancies pursuant to their quality control procedures and established procedures to prevent recurrence of discrepancy.

8. Identified problems as they occurred and/or suggested alternative approaches to problem resolutions.

9. Displayed initiative to solve problems and follow-up to ensure desired results were achieved.

10. Provided timely and courteous service to patients.

11. Was responsive to contract changes (if applicable).

12. Provided adequate supervision and manpower to meet established schedules.

13. Contractor adequately coped with any sudden surge in requirements (if applicable).

14. Contractor adequately coped with short notice requirements.

15. How would you rate the vendor's overall performance?

REMARKS/COMMENTS: