Attachment 1 - Past Performance Questionnaire.docx

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Sebra Complete Tube Sealing Kits to Naval Hospital Okinawa
Solicitation number
HT941023Q2045
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This document contains a past performance questionnaire template to evaluate an offeror for a federal contract to provide Sebra Complete Tube Sealing Kits to Naval Hospital Okinawa. The questionnaire requests ratings and comments on the offeror's performance on previous contracts in areas such as management, quality, schedule, cost control, and compliance. Respondents are asked to provide their name, agency, position, and contact information. They are highly encouraged to return the completed questionnaire to the offeror by September 1, 2023 to be submitted with its quote, or directly to the Defense Health Agency contact. An overall rating is also requested. Relevant experience includes contract number, title, award and completion dates, value, and role as prime or subcontractor.

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Combined Synopsis Solicitation (MAY 2023) - v2.docx DOCX document
Combined Synopsis Solicitation (MAY 2023) - Final.pdf PDF
Attachment 2 - Quote Sheet.xlsx XLSX spreadsheet
JA Brand Name - Redacted.pdf PDF

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Attachment 1

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Defense Health Agency (DHA) Western Markets Contracting Division is considering the Offeror listed below for a U.S. Government contract. Your comments would be appreciated regarding this firm’s past performance. After completing this PPQ, you are highly encouraged to send it back to the Offeror to be submitted with their quote. However, you may return it directly to this office via email to april.l.burbage.civ@health.mil no later than 10:00am Pacific Time Friday, September 1, 2023. Your prompt response is greatly appreciated. If the referenced project is a Government project, you may forward a copy of the official performance evaluation in lieu of completing this form. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

Offeror Information

Name of Offeror Being Evaluated:

Address of Offeror Being Evaluated:

Project Information

Contract Number:

Delivery/Task Order Number:

Contract/Project Title:

Location:

Award Date:

Completion Date:

Contract Value:

Offeror Performed As:
|_| Prime Contractor |_| Sub-Contractor

Description of Work Performed:

Evaluator Information

Name of Evaluator:

Government Agency/Commercial Company:

Address:

Phone Number:

Email Address:

Position Held in Relation to this Project:

Rating: Please evaluate the past performance using only the following ratings without variation.

DO NOT RATE ON A “+” OR “-” SCALE. If a “+” or “-” is used, the rating without the “+” or “-” will be applied. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.

“E”
Exceptional
Performance greatly exceeded the contract requirements.
“VG”
Very Good
Performance exceeded the contract requirements.
“S”
Satisfactory
Performance met the contract requirements.
“M”
Marginal
Performance met the minimum contract requirements, but some material aspects of the contractor’s performance were less than satisfactory.
“U”
Unacceptable
Performance was poor and/or did not satisfy contract requirements.
“NA”
Not Applicable
No information or did not apply to your contract.

Please rate and provide any supporting information/comments for the following:

1. The relationship between the Offeror and client’s/customer’s contract team:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

2. The Offeror’s management and coordination of subcontractors:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

3. Ability/actions to hire and retain a sufficient number of qualified employees for the performance of the contract work:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

4. Overall corporate management, integrity, reasonableness, and cooperative conduct:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

5. Quality of work:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

6. Quality control:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

7. Ability to meet the performance schedule:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

8. Ability/actions to improve schedule problems, if applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

9. Ability to control costs and provide the required work at a reasonable total price:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

10. Compliance with labor standards, as applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

11. Compliance with safety standards and/or number of safety related incidents, code compliance, as applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

12. Ability to submit required documentation (work schedule, reports, data, etc.) in a timely manner:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

13. Have any cure notices, show cause letters, letter of reprimand, suspension of payment, or termination been issued? If yes, please explain:
|_| |_|

Yes No

14. Was the contractor able to solve contract performance problems without extensive guidance from your procurement or technical personnel? If no, please explain:
|_| |_|

Yes No

15. Would you award another contract to the party being evaluated? If no, please explain:
|_| |_|

Yes No

16. Was the customer satisfied with the end product? If no, please explain:
|_| |_|

Yes No

17. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results?
|_| |_| |_|

Yes No NA

18. Additional Remarks:

19. Overall rating for this firm:
|_| |_| |_| |_| |_|

E VG S M U

Signature of Evaluator Date

PLEASE NOTE: Contractors may be advised of adverse remarks and given the opportunity to respond in accordance with Federal Acquisition Regulation (FAR) requirements. However, in accordance with FAR 15.306(e)(4), the names of individuals providing reference information about an Offeror’s past performance shall not be disclosed.

Past Performance Questionnaire, Page 1 of 3 (Rev 11/2022)

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