Attachment 4 - Past Performance Questionnaire.pdf

Attachment 4 – Past Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Travis AFB is in the process of soliciting offers from companies capable of providing:

Automated Coagulation System

In order for 60th Contracting Squadron to conduct its evaluation, we request that you complete the questionnaire below and email a PDF file to: nicholas.barrie.1@us.af.mil, Contract Specialist, at 60 CONS, Travis AFB. The due date for completed questionnaires is: 21 June 2024 at 12:00 PM Pacific Standard Time (PST). Your completed questionnaire will become 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: Nicholas Barrie by email at nicholas.barrie.1@us.af.mil.

mailto:diana.dressler@us.af.mil, mailto:diana.dressler@us.af.mil.

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 (List out Equipment Manufacture and Model#s

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 installation of the equipment and analyzers were completed in a timely manner and met expectations within the contract agreement.

2 Response time for technical support via telephone is prompt, available 24/7 and issue resolution is satisfactory.

3 On-site service response to instrument malfunctions is timely and issue resolution is satisfactory.

4 Reagents are delivered within expectations of the customer and rarely arrive unacceptable.

5 The contractor’s required analyzer maintenance allows for continued patient testing with minimal, if any, downtime and can easily be completed by a trained technician with less than two years of lab experience.

6 The contractor’s equipment has never been completely down due to mechanical issues, resulting in a halt or significant delay in all patient testing.

7 The equipment and data system have directly improved test turnaround times (e.g. STATs)

8 The equipment’s reference and education materials, job-aides, and package inserts are helpful to technicians to assist with day-to-day operations.

9 The equipment proficiently alerts the user to errors, to include quality control, function, patient tests, reagent requirements, expirations, etc.

10 Equipment is easy to operate; including maintenance, quality control, troubleshooting, patient testing, etc.

11 If assessed by the physicians and providers, the performance of the contractor’s equipment in the laboratory has produced timely, accurate, and quality test results.

12 Would you award another contract to this Contractor? If not, explain in “remarks.”

Yes No

Additional Remarks

Signature of respondent

Date