Attachment 2 - Past Performance Questionnaire.docx
DOCX document 33 KB Posted
- Attached to
- Calibration/Maintenance of Biomedical Test, Measurement and Diagnostic Equipment Services
- Solicitation number
- HT941026Q2043
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire attachment for a federal contract solicitation issued by the Defense Health Agency (DHA) Healthcare Contracting Division - West. The questionnaire serves as an evaluation tool for assessing contractor qualifications and experience relevant to the calibration and maintenance services requirement.
The questionnaire is designed to gather information about prospective contractors' past performance on similar biomedical test, measurement, and diagnostic equipment (TMDE) calibration and maintenance projects. Respondents are expected to provide detailed information demonstrating their capability to deliver trained technicians, supply management, equipment maintenance within original equipment manufacturer (OEM) specifications, and logistics support for international locations. The questionnaire evaluates contractor experience with equipment maintenance services, project management, technical expertise, and ability to support U.S. Naval Hospital Yokosuka and Branch Health Clinic locations in Iwakuni, Japan, and Diego Garcia. This small business set-aside solicitation (100% small business competition, NAICS code 811210, size standard $34 million) requires contractors to substantiate their qualifications through documented past performance examples that demonstrate relevant experience with similar scope, scale, and complexity of work in military or healthcare settings.
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Text version
Attachment 2
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 gilberto.a.esteves.civ@health.mil no later than 07/16/2026. 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)
File details come from the government source that posted it. Updated .