EXHIBIT B - Past Performance Questionnaire.docx
DOCX document 56 KB Posted
- Solicitation number
- HT9406-26-R-E006
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire template designed for evaluators to assess contractor experience and capabilities relevant to Healthcare Environmental Cleaning (HEC) Services at military treatment facilities in Germany. The questionnaire serves as a standardized evaluation tool for the Defense Health Agency's solicitation HT9406-26-R-E006 for European Healthcare Environmental Cleaning Services.
The document functions as an appendix to the draft RFP and does not specify detailed scoring criteria, response deadlines, or evaluation weightings within the questionnaire itself. Rather, it provides a structured format for offerors to document their past performance on similar healthcare facility cleaning contracts, management capabilities, quality control procedures, and relevant experience at comparable military or medical treatment facilities. The questionnaire is intended to help the Government evaluate contractor qualifications before award of the HEC services contract supporting Landstuhl Regional Medical Center, Medical Department Activity - Bavaria, and Rhine Ordinance Medical Center locations in Germany.
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Text version
HEC Past Performance Questionnaire (PPQ)
Exhibit B - Healthcare Environmental Cleaning (HEC) – Past Performance Questionnaire (PPQ)
Purpose: This PPQ is designed on behalf of the HEC Program for use by the Offeror to provide present and past performance data. The Defense Health Agency (DHA) will use the information provided to evaluate the quality of HEC services provided by the Offeror.
Instructions:
1. The offeror shall complete Part 1 and send the form to the point of contact (POC) for customers to complete Part 2: Performance Evaluation.
3. The customer shall complete and sign Part 2 and save the PPQ as a pdf.
4. The customer shall send the completed and signed PPQ to Ms. Hyun Townsley, Contract Specialist, DHA at hyun.j.townsley.civ@health.mil with “PPQ Submission” in the subject line.
Part 1: (to be completed by the Offeror)
| 1. Offeror |
| Name: |
| 2. Contractor performed as a |
| __ Prime |
__ Subcontractor
| 3. Prime contractor name if different than above |
| Name: |
| 4. Customer identified as |
| __ Commercial |
__ Federal Government __ State Government __ Other:
| 5. Offeror Point of Contact (POC) |
| Name: |
POC Phone Number:
POC Email:
| 6. Contract number/ Project Name |
| #: |
| 7. Contract award date |
| Date: |
| 8. Forecasted or actual contract completion date |
| Date: |
| 9. Performance period being evaluated. |
| Performance Period: |
| 10. The offeror shall describe the scope of the contract. |
| Check all Service Levels addressed in this effort. |
__ Service Level I
__ Service Level II
__ Service Level III
__ Service Level IV
__ Service Level V
__ Service Level VI
Provide a general description of services provided:
| 12. The offeror shall describe the magnitude of the contract. |
| Total Contract Value: $ |
Obligated amount for this specific evaluation period (if different from total contract value): $
End of Part 1.
Part 2: (to be completed by the customer)
2.1. Administrative.
Customer to complete responses below:
| 1. Customer’s Company/Agency |
| Name: |
| 2. Customer’s Company/Agency |
| Description: |
| 3. Customer Point of Contact |
| Name: |
Job Title:
Email:
Phone Number:
| 4. Please confirm that the contractor’s information provided in “Part 1” is accurate. |
| __ Yes |
__ No. If no, Please provide correction for here incorrect entry here:
2.2. Performance Level Descriptions. Please indicate the performance quality level achieved by the contractor in performance of the tasks listed below based on the performance level descriptions provided.
| Performance Level |
| Performance Level Description |
| Exceptional |
| The contractor’s performance meets contractual requirements and exceeds many requirements to the customer’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 customer’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 appear or was satisfactory. |
| Marginal |
| The contractor’s performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contract has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| Unsatisfactory |
| 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. |
| Not Applicable |
| Unable to provide a performance level. |
2.3. Quality Evaluation. The customer should rate the offeror’s performance on the above referenced contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable.
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.1. Subfactor 1. Quality. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory __ Not Applicable
Comment:
General Comments (General compliments, problems, and/or corrective actions taken to address the quality of services):
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.2. Subfactor 2. Schedule. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory
General Comments (General compliments, problems, and/or corrective actions taken to address schedule):
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.3. Subfactor 3. Management. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory
General Comments (General compliments, problems, and/or corrective actions taken to address the management services):
Customer POC Name:
Date completed:
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