Attachment 5 - Past Performance Questionnaire (PPQ) MFT 24-02.pdf

Attachment 5

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

Therapeutic Medical Physicist and Medial Dosimetrist Support Services

In order for 60th Contracting Squadron to conduct its evaluation, we request that you complete the questionnaire below and email a PDF file to:

Karly Zamiar, Contract Specialist 60 CONS, Travis AFB, CA karly.zamiar@us.af.mil

The due date for completed questionnaires is: 19 January 2024 at 11:00 AM Pacific Time.

Your completed questionnaire will become part of the official source selection records. To be considered, the Past Performance Questionnaire shall be returned directly to the Contract Specialist.

SECTION 1: CONTRACTOR BEING EVALUATED (Filled out by Contractor)

A. Company Name:

B. POC Name / Title:

C. POC Phone:

D. POC Email:

E. Contractor performed as: Prime Contractor Sub-Contractor

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104 mailto:judejames.rubrico@us.af.mil

SECTION 3: CONTRACT INFORMATION (Filled out by Customer/Evaluator)

A. Contract Name and/or Number:

B. Task Order Number:

C. Period of Performance (Base plus any Options):

D. Annual Contract Value:

E. Total Contract Value (Base plus all Options):

F. Number of FTEs:

G. Contract Description:

H. If the company was a Sub-Contractor, what percentage of the contract was performed by the evaluated contractor:

SECTION 2: EVALUATOR’S INFORMATION (Filled out by Customer/Evaluator)

A. Customer or Contracting Activity:

B. Address:

C. Evaluator's Name / Title:

D. Evaluator's Email:

E. Evaluator's Phone:

SECTION 4: PERFORMANCE INFORMATION (Filled out by Customer/Evaluator)

A. Choose the appropriate number on the scale (1, 2, 3, 4, or 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 nor 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 Contractor provided quality service that adhered to contract requirements.

2 The Contractor consistently responded to problems and took appropriate action to correct performance.

3 Did the contract involved hard to fill positions (specialty positions) or positions in high cost of living areas? If so, did Contractor successfully recruit and retain qualified contracted medical personnel with minimal disruption?

4 Contractor corrected deficiencies in a timely manner and pursuant to their contract requirements.

5 Contractor demonstrated an overall effective and quality management effort.

6 Contractor cooperated with the Government in providing flexible, proactive and effective solutions to critical contract issues.

Customer / Evaluator - Please Provide Comments Here:

THE CONTRACTOR 1 2 3 4 5

7 Contractor demonstrated ability to plan for and provide replacement candidates during the life of the contract to include preplanned absences, unplanned illnesses, or an extended leave of absence.

8 Contractor consistently demonstrated an ability to quickly recruit and retain qualified medical contract personnel in accordance with the contract requirements to avoid disruption of services and/or work schedule.

9 Credentialing packages (to include current and complete information) were presented timely to the applicable Credentialing office?

10 How would you rate the Contractor’s overall performance

Is the Contractor rated in CPARS?

Yes No

12 Was the Contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome below.

13 Would you award another contract to this Contractor? Please explain below.

Customer’s / Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire directly to:

Karly Zamiar, Contract Specialist Email: karly.zamiar@us.af.mil

Phone: (707) 424-7734 mailto:judejames.rubrico@us.af.mil