Attachment 5 - Past Performance Questionnare.pdf

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

Travis AFB is in the process of soliciting offers for companies capable of providing the following services at David Grant Medical Center:

Anatomic Pathology Oncology 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 Zamair, Contract Specialist

60 CONS, Travis AFB, CA karly.zamiar@us.af.mil

The due date for completed questionnaires is: 31 July 2024 at 11:00 AM PM 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 in its entirety and by the due date and time specified above.

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

A. Company Name:

B. Contract or Task Order Number:

C. POC Name / Title:

D. POC Phone:

E. POC Email:

F. Contractor performed as: Prime Contractor _____ Sub-Contractor _____ mailto:marcus.thomas.20@us.af.mil

SECTION 2: OFFEROR’S REFERENCE INFORMATION (Filled out by Offeror’s

Reference)

A. Reference’s Organization:

B. Reference’s Address:

C. Reference’s Name / Title:

D. Reference’s Email:

E. Reference’s Phone:

SECTION 3: CONTRACT INFORMATION (Filled out by Offeror’s Reference)

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: N/A

G. Contract Description:

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

SECTION 4: PERFORMANCE INFORMATION (Filled out by Offeror’s Reference)

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 Contractor provided all materials needed for testing (i.e. RPMI, Test collection kits, etc)

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.

7 Contractor maintained all necessary accreditation/credential requirements for all testing offered by the company.

THE CONTRACTOR 1 2 3 4 5

8 How would you rate the Contractor’s overall performance

9 Yes No

Is the Contractor rated in CPARS?

10 Was the Contractor ever issued a CAR, Cure or Show Cause notice under the referenced contract? If yes, explain outcome below.

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

Offeror’s Reference - PLEASE Provide Comments Here:

Offeror’s Reference 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:karly.zamiar@us.af.mil