Attachment 4_Past Performance Questionnaire_ 26RA037.docx
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- Solicitation number
- W81K00-26-R-A037
- Issued by
-
Department of the Army Medical Command
About this file
This is a Past Performance Questionnaire template for evaluating contractor performance on a competitive acquisition for Local National Occupational Health Services at Kaiserslautern Military Community in Sembach, Germany. The questionnaire is issued by Medical Readiness Contracting Office - West on behalf of Public Health Command-Europe and requests that identified contractor references complete and submit responses by 15 July 2026, 10:00 AM CT to wayne.v.thompson3.civ@health.mil and james.m.davis1.civ@health.mil.
The questionnaire solicits information regarding the contractor's past performance across eight key areas: contractor identification (prime and subcontractor names and contract/order numbers), service type, service location, total contract amount, full-time equivalent staffing levels, any unsatisfactory performance incidents resulting in additional costs, quality of service compliance with the Performance Work Statement, and business/customer relations effectiveness. Respondents rate performance using a four-point scale (Excellent, Satisfactory, Marginal, or Unsatisfactory), with mandatory narrative explanations required for any rating other than Satisfactory. The questionnaire emphasizes detailed and accurate historical performance documentation to support the government's evaluation of contractor capability and past performance for this occupational health services requirement.
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Text version
Attachment 4
W81K0026RA037
PAST PERFORMANCE QUESTIONNAIRE
Medical Readiness Contracting Office - West is conducting a competitive acquisition for Local National Occupational Health Services at Kaiserslautern Military Community, Sembach Germany, for Public Health Command-Europe. The offeror has identified you as a reference to validate past performance. Please complete the following questionnaire to assist with our evaluation of the contractor’s past performance.
Please complete the following questionnaire to assist our evaluation of the contractor’s past performance, and return to wayne.v.thompson3.civ@health.mil and james.m.davis1.civ@health.mil by 15 July 2026, 10:00 AM 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.
File details come from the government source that posted it. Updated .