Attachment 2 - Past Performance Questionnaire_23Q0092.docx

Attachment 2 W81K0023Q0092

PAST PERFORMANCE QUESTIONNAIRE

The Medical Readiness Contracting Office – West (MRCO-W) is conducting a competitive acquisition for Non-Personal Food Services Support for (1 FTE Food Service Supervisor and 13 FTE Food Service Worker/Cashier) for Evans Army Community Hospital (EACH), Fort Carson, Colorado. The offeror is requesting you complete/submit the following as a reference to validate past performance.

Please complete the following questionnaire to assist our evaluation of the contractor’s past performance and best value determination, and return to the Contract Specialist Brenda Ferjak at brenda.m.ferjak.civ@health.mil and the Contracting Officer Anthony Smith at anthony.j.smith138.civ@health.mil by 01 August 2023, 10:00 AM MT (Colorado Springs, Colorado). Note: Clearly identify and provide the name of the Prime Contractor and Subcontractor. Specify Prime Contractor/Subcontractor.

Name of Contractor being evaluated:

Contract/Order Number: __________________________________________________________________

1. Type of service being provided?

2. Where is the location of this service?

3. What is the contract amount?

4. How many Full Time Equivalents (FTE) and Labor Category are on the contract?

5. Have there been any unsatisfactory performance resulting in additional contractual or administrative costs?

Yes |_| No |_| If “Yes,” explain:

The last two questions will discuss quality of service & customer relations. Please refer to the following:

Rating System:

1. Excellent – Overall performance exceeds contractual requirements and gives extra benefits to the customer. Problems, if any, were promptly corrected without negative impact to the customer.

1. Satisfactory – Performance meets contractual requirements. The contractual performance contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory

1. Marginal - Performance does not meet some contractual requirements. The contractor’s proposed actions to correct any problems appear only marginally effective or were not fully implemented.

1. Unsatisfactory – Performance does not meet most contractual requirements. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

IMPORTANT NOTE: PLEASE INCLUDE A NARRATIVE FOR EACH SECTION

PAST PERFORMANCE QUESTIONNAIRE, Continued

6. Quality of Service – Please rate overall compliance with the contract Performance Work Statement.

(1) Excellent |_| (2) Satisfactory |_| (3) Marginal |_| (4) Unsatisfactory |_|

Please include a narrative to explain how the overall performance exceeds, meets, or does not meet contractual requirements:

8. Business/Customer Relations – Please rate overall effective management; successfully managed services; reasonable/cooperative behavior; flexibility; business-like concern for customer’s interest.

(1) Excellent |_| (2) Satisfactory |_| (3) Marginal |_| (4) Unsatisfactory |_|

Please include a narrative to explain how the overall performance exceeds, meets, or does not meet contractual requirements:

Signature: Date:

Print Name: Company:

Title: Telephone:

Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.