Attachment 3 - Past Performance Questionnaire.docx

Solicitation HT941025Q2017 Attachment 3

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

The Defense Health Agency (DHA) is conducting a Fair Opportunity competition. The offeror has identified you as a reference to validate past performance.

Solicitation HT941025Q2017 is to provide Medical Courier Services at the 354th Medical Group, Eielson AFB, Alaska.

Please complete the following questionnaire to assist our evaluation of the Contractor’s past performance and email to John Lam Ho at ho.j.lam.civ@health.mil.

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:

MAGNITUDE

Annual Contract Value:

Total Contract Dollar Value:

Contractor performed on this contract as:

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.

Courier Services

Provided vehicle in good operating condition and meeting state requirements

Provided timely courier services between facilities during normal operating hours

Provided timely courier services between facilities outside of normal operating hours

Provided a complete manifest showing materials to be transported to the receiving facility

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:

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.