Attachment 4 Past Performance Questionnaire.docx

ATTACHMENT 4: PAST PERFORMANCE QUESTIONNAIRE

The Southern Markets Contracts Division is conducting a Small Business (SB) set-aside award. The offeror has identified you as a reference to validate past performance.

RFQ HT9408-22-Q-0008 is for non-personal services of one (1) FTE Education and Training Manager for Columbus AFB, MS

Please complete the following questionnaire to assist our evaluation of the contractor’s past performance, and return via email no later than 25 August 2022 at 2:00 PM CDT to caitlin.e.hippensteel.civ@mail.mil (also copy caitlin.e.hippensteel.civ@health.mil) and thomas.l.steinman.civ@mail.mil (also copy thomas.l.steinman.civ@health.mil) NLT Thursday, 25 August 2022 at 2:00pm CDT (1:00pm EDT). Please note DHA is undergoing a migration of all e-mail addresses to health.mil. Please use both email addresses for each POC above to ensure that all correspondence is received.

Name of Contractor being evaluated:

1. How long has your company had a contract with this contractor?

2. What services are being provided?

3. Where is the location of this service?

4. What is the contract amount?

5. How many Full Time Equivalents (FTE) are on the contract?

6. Have there been late deliveries or other unsatisfactory performance resulting in additional contractual or administrative costs? If yes, please explain:

7. Given the opportunity, would you work with this company again?

8. Have there been incidences where contracted positions have been unable to be filled? If yes, please explain:

The last three questions will discuss schedule performance, quality of service & customer relations.

Please refer to the following Rating System:

(1) Excellent - Performance meets contractual requirements and exceeds many to the contractor’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken were highly effective.

(2) Very Good - Performance meets contractual requirements and exceeds some to the Contractor’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken were effective.

(3) Satisfactory - Performance meets the contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken appear or were satisfactory.

(4) Marginal - Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The proposed actions appear only marginally effective or were not fully implemented.

(5) Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a manner. The contractual performance of the element contains serious problem(s) for which corrective actions appear or were ineffective.

1. Schedule Performance – Please rate overall compliance with reliability and timeliness of scheduled performance.

(1) Excellent (2) Very Good (3) Satisfactory (4) Marginal (5) Unsatisfactory

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

2. Quality of Service – Please rate overall compliance with contract statement of work requirement.

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

3. Business/Customer Relations – Please rate overall effective management; successfully managed services; reasonable/ cooperative behavior; flexibility; business-like concern for customer’s interest.

If other than “Satisfactory, “please 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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