DRAFT RFP2 GSP Past Performance Questionnaire.docx

HT001522R0030 Attachment RFP2- GSP Past Performance Questionnaire (PPQ)

Part 1: (to be completed by the Offeror)

__ State Government __ Other:

POC Phone Number:

POC Email:

__ Scope Area 1: IT Service Desk. This include services such as trouble shooting, desk-side support, remote user assistance, and installation support. See GSP PWS Section 5.2 for detailed description.

__ Scope Area 2: Database, Application, and Web Development. This includes implementing and monitoring database architectures, managing databases, database administration, and web development and support services. See GSP PWS Section 5.3 for detailed description.

__ Scope Area 3: Identity Management and Desktop Support. This includes active directory management, medical joint active directory organizational units, desk-side, and remote user assistance. See GSP PWS Section 5.4 for detailed description.

__ Scope Area 4: Data Center Operations. This includes full life-cycle Data Center Operation services IAW enterprise standards and other Government policies. See GSP PWS Section 5.5 for detailed description.

__ Scope Area 5: Information Assurance. This includes enterprise and local site Information Assurance (Cybersecurity) services. See GSP PWS Section 5.6 for detailed description.

__ Scope Area 6: Network Operations. This includes overall network infrastructure (i.e. local area network (LAN), wireless local area network (WLAN), wide area network (WAN)) at a site and respond to, detect, report, record, diagnose and resolve network issues as well as measure network performance and connectivity on an ongoing basis. See GSP PWS Section 5.7 for detailed description.

__ Scope Area 7: Telecommunications. This includes analog, digital, and Voice Over IP telecommunication services. See GSP PWS Section 5.8 for detailed description.

Provide a general description of IT services provided:

Part 2: (to be completed by the customer)

Job Title:

Email:

Phone Number:

__ No. If no, Please provide correction for here incorrect entry here:

Part 3: (to be completed by the customer, see description below)

__ Less than Satisfactory

__ Less than Satisfactory

__ Less than Satisfactory

Customer POC Signature:

Date completed:

Instructions and Descriptions This Past Performance Questionnaire (PPQ) is designed on behalf of the Defense Health Agency’s (DHA) Geographic Service Provider (GSP) acquisition for use by the Offeror to retrieve past performance information. The DHA will use the information provided for the GSP evaluation.

1. The Offeror shall complete Part 1 and save.

2. The Offeror shall send the form to the point of contact (POC) for its customer to complete Part 2 and Part 3. The customer POC shall be a current or former employee of the customer organization with first-hand knowledge of the offeror’s performance or have access to first-hand records.

3. The customer shall complete Part 2 and Part 3, sign, and save “as a PDF document” with a signature. (See additional instructions below.)

4. The customer shall return to the completed and signed PPQ to the Offeror.

5. The Offeror shall include the completed PPQ in Volume V of its proposal.

Performance Level Descriptions used in Part 3. Using the Performance Level Descriptions, please indicate the performance level achieved by the Offeror (contractor) in execution of the tasks in the Scope Areas annotated.

The contractor’s performance meets contractual requirements and exceeds some requirements to the customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective. OR

The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions appear or was satisfactory.

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

Options for saving and returning PPQ to Offeror.

Option 1 (preferred by DHA)

· Type Name and date above.

· Click “File” then “Save as Adobe PDF”. Saving as an Adobe PDF will save the document and lock the document so that your ratings cannot be changed.

· Once the document is saved as a PDF document, the customer has the option of selecting “certificate” and “digitally sign”. An electronic signature may be placed above Customer POC Name if desired.

· Save the signed document.

· Return Adobe PDF to the Offeror so that it can submit this PPQ with the proposal.

Option 2

· Type Name and date above.

· Click “File” then “Protect Document” then “Mark as Final.” Finish saving the document.

· Return final version of word document to the offeror so that they can submit this PPQ with the proposal.

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