Attachment 2 - RFQ HT941026Q2053_Past Performance Questionnaire.docx
DOCX document 35 KB Posted
- Solicitation number
- HT941026Q2053
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire (PPQ) template used by the Defense Health Agency's Healthcare Contracting Division - West to evaluate contractor performance for solicitation HT941026Q2053, which concerns Surgical Instrument Sharpening and Repair Services at Mike O'Callaghan Military Medical Center. The questionnaire is completed by past customers or contracting activities to validate an offeror's performance history and inform the government's evaluation of proposals submitted in response to a Fair Opportunity competition conducted under FAR Part 12.
The PPQ assesses contractor performance across four primary rating areas aligned with CPARS (Contractor Performance Assessment Reporting System) metrics: Overall Fill Rate (Quality of Service), On-Time Fill Percentage (Schedule), Turnover Rate (Management), and Replenishment Rate (Management). Respondents rate performance using a five-point scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory) or mark Not Applicable, with detailed performance definitions provided. Key evaluation criteria focus on the contractor's ability to provide qualified healthcare workers, maintain filled positions, meet scheduling requirements, provide complete credentialing packages, retain personnel with minimal turnover, and plan for replacement coverage during absences. The questionnaire requests contract-specific information including contract number, performance period, annual and total contract values, contractor role (prime, subcontractor, teaming partner, or joint venture), and status of project performance. Respondents conclude by indicating willingness to award a future contract, noting any defaults or terminations, and providing additional comments. The template includes fields for respondent and contractor contact information and requires signature and date authentication.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachement 1 - Combined Synopsis Solicitation -.pdf | ||
| Attachement 4 - SOW Surgica Insturment Sharpening and Repair Service 7.21.26 v4.pdf | ||
| Attachment 3 - Pricing Worksheet.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
HT941026Q2053
ATTACHMENT 2
PAST PERFORMANCE QUESTIONNAIRE (PPQ)
The DHA Healthcare Contracting Division – West is conducting a Fair Opportunity competition for contract holders IAW FAR 12. The offeror has identified you as a reference to validate past performance.
Please complete the following questionnaire to assist our evaluation of the Contractor’s past performance.
RESPONDENT INFORMATION:
Contracting Activity/Customer:
Point of Contact (POC):
Title of POC:
Telephone:
Email:
OFFEROR’S REFERENCE INFORMATION:
Contractor Name:
Point of Contact (POC):
Telephone Number:
Email:
CONTRACT INFORMATION:
Contract Number:
Task Order Number:
Type of Contract:
Performance Period: (Base plus any options):
Description of Services:
MARKET SEGMENT
| Ancillary Services |
| Dental Services |
| Nursing Services |
| Physician Services |
MAGNITUDE
Annual Contract Value:
Total Contract Dollar Value:
COMPLEXITY
Contractor performed on this contract as:
| Prime |
| Subcontractor |
| Teaming Partner |
| Joint Venture |
Status of the Project:
Identify status of performance reporting and how many years have successfully been completed. Identify any terminations or modifications for scope change.
Please refer to the following assessment definitions to assess the Contractor’s performance in each of the areas listed in this questionnaire:
(E) Exceptional - The Contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.
(V) Very Good - The Contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.
(S) Satisfactory - The Contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Contractor appear or were resolved satisfactorily.
(M) Marginal - Performance does not meet some contractual requirements. The contractual performance 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.
(U) Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.
(N) Not Applicable – Unable to assess the area.
Overall Fill Rate (CPARS “Quality of Service” Rating Area)
| Assess how the Contractor: |
| E |
| V |
| S |
| M |
| U |
| NA |
Provided qualified Health Care Workers (HCW) IAW the terms and conditions of the contract.
Ensured that qualified HCW’s remained filled IAW the terms and conditions of the contract.
Recruited, placed, and retained qualified HCW’s with minimal disruption for hard-to-fill (specialty) positions or at remote locations.
If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:
On-Time Fill Percentage (CPARS “Schedule” Rating Area)
| Assess how the Contractor: |
| E |
| V |
| S |
| M |
| U |
| NA |
Provide qualified HCW’s on time IAW the terms and conditions of the contract.
Provided complete, current and accurate qualifying package for each HCW IAW the terms and conditions of the contract.
Provided complete, current and accurate credentialing/privileging packages within established time frames IAW the terms and conditions of the contract.
If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:
Turnover Rate (CPARS “Management” Rating area)
| Assess how the Contractor: |
| E |
| V |
| S |
| M |
| U |
| NA |
Retained qualified HCWs without frequent turnover and minimal operations disruption IAW the terms of the contract.
If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:
Replenishment Rate (CPARS “Management” Rating area)
| Assess how the Contractor: |
| E |
| V |
| S |
| M |
| U |
| NA |
Planned for and provided replacement candidates during the life of the contract to, include pre-planned/unplanned absences and extended leave of absence to avoid disruption of services and/or work schedule IAW the terms of the contract.
If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:
| PERFORMANCE SUMMARY |
| Yes |
| No |
Would you award this firm another contract:
If you answered “No” provide an explanation:
Was the contract terminated for default or cause:
If you answered “Yes” provide an explanation:
Additional Comments:
Signature: _________________________________________ Date: __________________
Print Name: _________________________________________
Title: _______________________________________________
Telephone: __________________________________________
Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.
As of 7 Feb 25
File details come from the government source that posted it. Updated .