Attachment 3_Past Performance Questionnaire_ W81K0026QA061.docx
DOCX document 30 KB Posted
- Attached to
- Intraoperative Neuromonitoring
- Solicitation number
- W81K0026QA061
- Issued by
-
Department of the Army Medical Command
About this file
This is a Past Performance Questionnaire used by the Medical Readiness Contracting Office - West (MRCO-W) to evaluate contractor references in support of a competitive acquisition for Intraoperative Neuromonitoring Services at Brooke Army Medical Center (BAMC) on Fort Sam Houston, Texas. The questionnaire is designed to be completed by past customers or references who have worked with the offeror to validate their performance history. Responses must be returned to cathy.l.harris2.civ@health.mil and james.m.davis1.civ@health.mil by February 25, 2026, at 1:00 PM Central Time.
The questionnaire requests information about the contractor's service type, service location, total contract amount, and number of Full Time Equivalents assigned to the contract. Respondents must assess whether unsatisfactory performance resulted in additional contractual or administrative costs and provide detailed ratings in two critical areas using a four-point scale: Quality of Service (rating overall compliance with the Performance Work Statement) and Business/Customer Relations (evaluating effective management, service delivery, cooperation, flexibility, and customer concern). Any rating other than "Satisfactory" requires supporting narrative explanation. This template is part of Solicitation W81K0026QA061, with a solicitation due date of February 25, 2026, and a questions deadline of February 17, 2026.
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ATTACHMENT 3
W81K0026QA061
PAST PERFORMANCE QUESTIONNAIRE
The Medical Readiness Contracting Office – West (MRCO-W) is conducting a competitive acquisition for Intraoperative Neuromonitoring Services in support of the Department of Surgery at the Brooke Army Medical Center (BAMC) at Joint Base San Antonio, located on Fort Sam Houston, TX. 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, and return to cathy.l.harris2.civ@health.mil and james.m.davis1.civ@health.mil by 25 Feb 2026, 1:00PM CT
Name of Contractor being evaluated:
Note: Clearly identify and provide the name of the Prime Contractor and Subcontractor. Specify Prime Contractor/Subcontractor if known.
Contract/Order Number: __________________________________________________________________
1. Type of service being provided?
2. Where is the location of this service?
3. What is the total contract amount?
4. How many Full Time Equivalents (FTE) 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.
(2) Satisfactory – Performance meets contractual requirements. The contractual performance contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory
(3) 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.
(4) 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: NARRATIVES MUST BE PROVIDED FOR ANY RATING OTHER THAN SATISFACTORY AND MUST SUPPORT THE RATING GIVEN.
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 |_|
If other than “Satisfactory,” a narrative must be provided to explain how the overall performance exceeds or does not meet contractual requirements:
7. 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 |_|
If other than “Satisfactory,” a narrative must be provided to explain how the overall performance exceeds 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.
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