Attachment 3 - Past Performance Questionnaire (PPQ).doc
DOC document 86 KB Posted
- Attached to
- Opthtalomogy Laser Maintenance - Travis AFB, CA - Amendment 1 Federal contract opportunity
- Solicitation number
- FA442720R0047
About this file
This document contains a past performance questionnaire for a contractor providing ophthalmology laser maintenance services at Travis Air Force Base in California. The questionnaire is being distributed to evaluate offers for a new contract to provide preventative maintenance for government-owned ophthalmology lasers, including service by OEM-certified technicians using new OEM parts, preventative maintenance, unlimited repairs with all parts and labor, manufacturer technical support, and service reports. Responses to the past performance questionnaire are due by August 31, 2020 at 1:00 PM Pacific Time and will become part of the official source selection records. The contract specialist points of contact for any questions are provided.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment FA442720R00470001 SF 30.pdf | ||
| Attachment 2 - Reference Sheet.pdf | ||
| Solicitation - FA442720R0047.pdf | ||
| Attachment 1 - PWS Opthtalomogy Laser Maintenance v2.pdf | ||
| Attachment 4 - Wage Determination 15-5656.pdf |
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Text version
Attachment 5 -
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
Travis AFB is in the process of soliciting offers from companies capable of providing:
Ophthalmology Lasers Maintenance In order for 60th Contracting Squadron to conduct its evaluation, we request that you complete the questionnaire below and email a PDF file to: juliet.diggs.1@us.af.mil, AND vitaliy.kim@us.af.mil. The due date for completed questionnaires is: 31 Aug 2020 at 1:00 PM Pacific Time. Your completed questionnaire will become a part of the official source selection records. To be considered, the Past Performance Questionnaire shall be returned to the Contract Specialist in its entirety and by the due date and time specified above.
To confirm receipt of your completed/submitted questionnaires, please contact:
Contract Specialist: Juliet Diggs by email at juliet.diggs.1@us.af.mil, Tel: 707-424-7772.
A. OFFEROR’s REFERENCE INFORMATION:
Contract Name and/or Number (Include task order number(s) if applicable:
Company (Include task order number(s) if applicable:
Address:
POC of Contact (POC):
Title of POC:
Telephone Number:
Email:
Contractor performed as:
Prime Contractor ____ Sub-Contractor ____
B. RESPONDENT INFORMATION: Please complete
Contracting Activity/Customer:
Address:
Telephone Number:
Email Address:
Point of Contract (POC)
Title of POC:
C. CONTRACT INFORMATION: Please Complete.
Contract Name and/or Number
Task Order Number:
Type of Contract:
Performance Period (Base plus any options)
Annual Contract Value:
Total Contract Dollar Value: (base plus options)
Contract Description:
| Contractor performed as: |
| Prime Contractor: _____ |
Sub-Contractor: _____
If sub-Contractor: What percentage was performed by the evaluated Contractor
A. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (1, 2, 3, 4, and 5) that most accurately describes the Contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 4 or 5.
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
Substantial Confidence
Satisfactory Confidence
| Neutral Confidence |
| Limited Confidence |
No Confidence
Based on the offeror’s recent/relevant performance record, the
Government has a high expectation that the offeror will successfully perform the required effort.
Based on the offeror’s recent/relevant performance record, the
Government has a reasonable expectation that the offeror will successfully perform the required effort.
No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.
The offeror may not be evaluated favorably or unfavorably on the factor of past performance.
Based on the offeror’s recent/relevant performance record, the
Government has a low expectation that the offeror will successfully perform the required effort.
Based on the offeror’s recent/relevant performance record, the
Government has no expectation that the offeror will be able to successfully perform the required effort.
Place an “X” in the appropriate column using the definitions matrix above.
| THE CONTRACTOR |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 1 |
| The Contractor provided quality service that adhered to contract requirements. |
| 2 |
| The Contractor consistently responded to problems and took appropriate action to correct performance. |
| 3 |
| Did the contract involved hard to fill positions (specialty positions) or positions in high cost of living areas? If so, did Contractor successfully recruit and retain qualified contracted medical personnel with minimal disruption? |
| 4 |
| Contractor corrected deficiencies in timely manner and pursuant to their contract requirements. |
| 5 |
| Contractor demonstrated an overall effective and quality management effort. |
| 6 |
| Contractor cooperated with the Government in providing flexible, proactive and effective solutions to critical contract issues. |
| 7 |
| Contractor demonstrated ability to plan for and provide replacement candidates during the life of the contract to include preplanned absences, unplanned illnesses, or an extended leave of absence. |
| 8 |
| Contractor consistently demonstrated an ability to quickly recruit and retain qualified medical contract personnel in accordance with the contract requirements to avoid disruption of services and/or work schedule. |
| 9 |
| Credentialing packages (to include current and complete information) were presented in timely to the applicable Credentialing office? |
| 10 |
| How would you rate the Contractor’s overall performance |
| Yes |
| No |
Is the Contractor rated in CPARS?
Was the Contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
| 13 |
| Would you award another contract to this Contractor? If not, explain in “remarks.” |
Additional Remarks Date and Signature
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