Attachment 5 - Past Performance Questionnaire (PPQ).pdf

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

MEDICAL ADMINISTEATIVE SERVICES (Med Admin 10)

FAIRCHILD AFB, WA

SOLICITATION NO: FA462021RA201

1. Your assistance is respectfully requested in providing information on the below present/past performance questionnaire. The importance of your opinion cannot be overstated since this survey will measure the present/past performance of each prospective offeror for providing Medical Administrative Services at Fairchild AFB, WA.

2. INSTRUCTIONS FORM COMPLETION: Please fill this questionnaire in by hand or electronically and email the results to the Contract Specialist(s), Zachery Ray, at zachery.ray.2@us.af.mil and Chance Halstead at chance.halstead@us.af.mil. Email submissions are preferred but you can also return by mail to the following address:

92 CONS/PKA

Attn: SrA Chance Halstead or Mr. Zachery Ray 110 W. Ent St Fairchild AFB WA 99011

3. Please direct questions to Zachery Ray (509) 247-2608. Your Participation is greatly appreciated.

4. PLEASE RETURN NO LATER THAN: 15 June 2021, at 1:00 PM (Pacific Time)

Section A: Contractor Information.

Contractor’s name and address:

a. Point of Contact:

b. Phone #:

c. Contract Number:

d. Project Title:

e. Period of Performance:

SECTION B: RESPONDENT INFORMATION

a. Respondent’s name and address: Organization: _

Address:

City: _ State: _ Zip: _

b. Respondent’s Name and Title:

c. Signature:

d. Commercial Phone #: DSN Phone #:

Fax #: E-Mail:

e. Contract Type (i.e.: Firm Fixed Price):

f. Award Amount: $ Final Amount: $

g. What was the job title for this project?

FA462021RA201

Med Admin 10

Attachment 5 - PPQ

What were the scope and major functions performed under this contract?

If you have questions regarding this questionnaire, please call Zachery Ray @ 509-247-2608.

For any ratings less than satisfactory rating, please provide explanation in Remarks section below.

1 2 3 4 5 Unsatisfactory Marginal Satisfactory Very

Good Exceptional

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

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions.

The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory

Performance meets contractual requirements and exceeds some to the Government’s benefit.

The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

The Contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit.

The contractual performance was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.

CONTRACTOR PRESENT/PAST PERFORMANCE EVALUATION

1. How effective was the contractor’s recruitment plan for filling the required positions and providing replacements for personnel that discontinued employment under this contract?

5. 4. ____3. ____2. ____1.

COMMENTS/REMARKS:

2. How effective was the contractor in maintaining professional business relationships with government personnel and in resolving contract issues?

3. How well did the contractor personnel perform assigned office administrative duties?

FA462021RA201

4. How was the overall appearance and professionalism of the contractor personnel?

5. How well did personnel perform records management and documentation?

6. Was the contractor personnel knowledgeable and experienced in their position?

7. How effective was the contract personnel in maintaining professional business relationships with government personnel and in resolving contract issues?

8. How would you rate the contractor's overall performance?

9. Were Contract Discrepancy Reports (CDR) issued, Yes/No ____ Were they addressed appropriately? Yes/No ______ If so, how?

10. Was the contractor ever issued a cure or show cause notice under the referenced contract? Yes/No ___

11. Would you award another contract to this contractor? Yes/No ____ Please explain in "remarks”.

REMARKS:

FA462021RA201