Attach 4-Past Performance Questionnaire Rev 1.docx
DOCX document 35 KB Posted
- Attached to
- Warfighter/Ophthalmology Clinic Staffing Federal contract opportunity
- Solicitation number
- FA301021R0014
About this file
This document contains a past performance questionnaire and details of a federal contract opportunity. The past performance questionnaire is seeking information about an offeror's performance on a previous contract to provide one full time equivalent refractive surgery optometrist, five ophthalmic technicians, one clinic manager and two medical records clerks. Responses to the questionnaire are due by July 29, 2021 at 3:00PM CST.
The related federal contract opportunity is being issued by the 81st Contracting Squadron of the Department of the Air Force to obtain the same services for the Keesler Medical Center at Keesler Air Force Base in Mississippi. The period of performance is expected to be from October 1, 2021 to September 30, 2022 with options to extend up to an additional 48 months. Questions about the solicitation must be submitted in writing and directed to the specified contracting personnel by the given deadlines.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| FA301021R0014 Questions_Answers.pdf | ||
| Amendment FA301021R00140001 SF 30.pdf | ||
| Attach 4-Past Performance Questionnaire.docx | DOCX document | |
| Attach 2-WD 15-5147 Rev 13.pdf | ||
| Solicitation - FA301021R0014.pdf | ||
| Attach 3-Past Performance List of References.pdf | ||
| Attach 1-PWS Warfighter Opthamology Clinic 1 Jun 2021.pdf |
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Text version
Attachment 4 Solicitation #: FA301021R0014 War-Fighter Ophthalmology Clinic Staff
PAST PERFORMANCE QUESTIONNAIRE
Keesler AFB is in the process of soliciting offers from companies capable of providing:
War-Fighter Ophthalmology Clinic: 1 FTE Refractive Surgery Optometrist, 5 FTE Ophthalmic Technicians, 1 FTE Clinic Manager and 2 FTE Medical Records Clerks
In order for the 81st Contracting Squadron to conduct its evaluation, we request that you complete the questionnaire below and e-mail a PDF file to samantha.conger@us.af.mil, Contract Specialist, at 81 CONS, Keesler AFB. The due date for completed questionnaires is 7/29/2021 at 3:00PM CST. Your completed questionnaire will become a part of the official source selection records. To be considered, the Past Performance Questionnaire shall be returned to the Contract Specialist in its entirety and by the due date and time specified above.
To confirm receipt of your completed/submitted questionnaires please contact Contract Specialist, Samantha Conger, by e-mail at samantha.conger@us.af.mil.
A. OFFEROR’S REFERENCE INFORMATION:
Contract Name and/or Number (include task order number(s) if applicable)
Company/Division Name to be evaluated
Address:
Point of Contact (POC):
Title of POC:
Telephone Number:
Contractor performed as: Prime contractor Contractor performed as: Sub-Contractor Joint Venture Affiliate To/With _____________________
B. RESPONDENT INFORMATION: Please complete.
Contracting Activity/Customer
Address:
Telephone Number:
Email Address:
Point of Contact (POC):
Title of POC:
C. CONTRACT INFORMATION: Please complete.
Contract Name and/or Number
Task Order number:
Type of Contract:
Performance Period: (Base plus any options):
Performance Period for the task order:
Annual Contract Values:
Total Contract Dollar Value: (base plus any options)
Number of FTEs / Session-based:
Contract Description:
Contractor performed as: Prime contractor Contractor performed as: Sub-Contractor Joint Venture Affiliate To/With _____________________ What percentage of the contract was performed by the evaluated contractor, if available: ………………...%.
Instructions:
Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings.
| RATING |
| DEFINITION |
| Exceptional |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory |
| Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective |
| N/A |
| Not Applicable |
PAST PERFORMANCE QUESTIONNAIRE
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
N/A
A. QUALITY OF SERVICE AND PERFORMANCE
(1) The Contractor provided quality service that adhered to contract requirements, specifications, and standards of professional conduct.
(2) The Contractor consistently responded to problems and took appropriate action to correct performance.
(3) Did the contract involve hard to fill positions (specialty positions) or positions are remote locations? If so, Contractor successfully recruited and retained qualified Ancillary HCPs with minimal disruption.
B. MANAGEMENT
(1) Contractor was able to resolve customer complaints quickly and effectively.
(2) Contractor demonstrated an overall effective and quality management effort.
(3) Contractor cooperated with the Government in providing flexible, proactive and effective solutions to critical contract issues.
C. TIMELINESS/ SCHEDULE OF PERFORMANCE/SERVICES
(1) Contractor demonstrated ability to plan for and provide replacement candidates during the life of the contract to include pre-planned absences, unplanned illnesses, or an extended leave of absence.
(2) The Contractor consistently demonstrated an ability to quickly recruit and retain qualified HCPs in accordance with contract requirements and to avoid disruption of services and/or work schedule.
(3) Credentialing Packages (to include current and complete information) were presented in timely fashion to the applicable facility.
D. OTHER:
(1) Would you award this firm another contract? ( ) Yes ( ) No If you answered “No” provide an explanation. ____________________________________________________
(2) Was the contract terminated for default or cause? ( ) Yes ( ) No If you answered “Yes”, provide an explanation.___________________________________________________
(3) Has the Contractor been given a cure notice, show cause notice, suspension of progress payments in the last 3 years. ( ) Yes ( ) No If you answered “Yes”, provide an explanation and how many actions and if they were resolved: ________________________________________________________________________________________
(4) ADDITIONAL COMMENTS: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
RESPONDENT SIGNATURE
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