DRAFT - Exhibit D - Past Performance Questionnaire FINAL.pdf

Solicitation Number

RFP HT001526RE001

Exhibit D

EXHIBIT D - PAST PERFORMANCE QUESTIONNAIRE

This questionnaire must be filled out and signed by the past performance reference. The reference will submit all completed and signed questionnaires via email to tamara.k.fenwick.civ@health.mil and melissa.l.hearst.ctr.@health.mil

The DHA Enterprise Medical Services - Contracting Division is conducting a Single Award ID/IQ competition for Solicitation Number, HT0015-26-R-E001. This solicitation is for qualified Reference Laboratory Testing Services to support the DHA Enterprise CONUS and OCONUS: over 6,000 required laboratory tests to approximately 200 Military Treatment Facilities.

RESPONDENT INFORMATION:

Contracting Activity/Customer:

Point of Contact (POC):

Title of POC:

Telephone:

Email:

OFFEROR’S REFERENCE INFORMATION: (to be filled out by the contractor)

Contractor Name:

Point of Contact

(POC):

Telephone Number:

Email:

CONTRACT INFORMATION: (to be filled out by the contractor)

Contract Number:

Task Order Number:

Type of Contract:

Performance Period: (Base plus any options):

mailto:tamara.k.fenwick.civ@health.mil mailto:melissa.l.hearst.ctr.@health.mil

Exhibit D

Description of Services:

MAGNITUDE

Annual Contract Value:

Total Contract Dollar Value:

COMPLEXITY

Geographic description of services under this contract:

Approximate number of laboratory tests performed annually under this contract:

STAT Courier Services provided under this contract:

Yes No

Contractor performed on this contract as:

Prime Subcontractor

Teaming Partner Joint Venture

Please refer to the following assessment definitions to assess the Contractor’s performance in each of the areas listed in this questionnaire:

Exceptional - 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.

Very Good - The Contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.

Satisfactory - The Contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Contractor appear or were resolved satisfactorily.

Exhibit D

Marginal - Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the Contractor has not yet identified corrective actions or the Contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory - Performance does not meet most contractual requirements and recoveryis not likely in a timely manner. The contractual performance contains serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

Not Applicable – Unable to assess the area.

Quality of Service

Assess how the Contractor: The Contractor’s performance is/was:

Provided services that conformed to contract requirements, specifications, and standards of good workmanship.

Submitted accurate reports/surveys.

Utilized personnel that were appropriate to the effort performed.

Established and maintained adequate management of subcontractors to ensure quality service.

If other than “Satisfactory” explain how the performance exceeds or does not meet contractual requirements:

Cost Control

Assess how the Contractor: The Contractor’s performance is/was:

Performed the effort within the estimated cost/price.

Submitted accurate invoices on a timely basis.

Demonstrated cost efficiencies in performing the required effort.

The actual costs/rates realized closely reflected the negotiated costs/rates.

If other than “Satisfactory” explain how the performance exceeds or does not meet contractual requirements:

Timeliness/Schedule

Assess how the Contractor: The Contractor’s performance is/was:

Performed tasks required under this effort in a timely manner and in accordance with the period of performance of the contract.

Exhibit D

Was responsive to technical and/or contractual direction.

Test turnaround time was timely and within the requirements of this effort.

If other than “Satisfactory” explain how the performance exceeds or does not meet contractual requirements:

Business Relationships

Assess how the Contractor: The Contractor’s performance is/was:

Demonstrated effective management over the effort performed.

Maintained an open line of communication so that the Contracting Officer’s Representative (COR) was apprised of technical, cost, and schedule issues.

Presented information, reports, surveys and correspondence in a clear, concise, and businesslike manner.

Promptly notified the COR and/or Contracting Officer in a timely manner regarding urgent issues.

Cooperated with the Government in providing flexible, proactive, and effective recommended solutions to critical contract issues.

If other than “Satisfactory” explain how the performance exceeds or does not meet contractual requirements:

Key Personnel

Assess how the Contractor: The Contractor’s performance is/was:

Provided qualified personnel to fulfill the requirements of the contract.

If other than “Satisfactory” explain how the performance exceeds or does not meet contractual requirements:

PERFORMANCE SUMMARY

Would you award this firm another contract: Yes No

If you answered “No” provide a brief explanation:

Was the contract terminated for default or cause:

Yes No

Exhibit D

If you answered “Yes” please provide an explanation:

Additional Comments:

Evaluator Name (Print):

Title:

Telephone: Email:

Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.

Date:Evaluator Signature

Please refer to the following assessment definitions to assess the Contractor’s performance