PAST PERFORMANCE QUESTIONNAIRE3 - Inpatient Transcription.docx
DOCX document 18 KB Posted
- Attached to
- Inpatient Transcription Services Federal contract opportunity
- Solicitation number
- FA4427-09-R-0009
About this file
Word Version of the revised Past Performance Questionnaire
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| PAST PERFORMANCE QUESTIONNAIRE4 - Inpatient Transcription.docx | DOCX document | |
| PAST PERFORMANCE QUESTIONNAIRE4- Inpatient Transcription.pdf | ||
| FA4427-09-R-0009-0003.pdf | ||
| PAST PERFORMANCE QUESTIONNAIRE3 - Inpatient Transcription.pdf | ||
| Additional QandA5.pdf | ||
| A-1 Performance Work Statement - Medical Transcription - 21 Aug 09.pdf | ||
| FA4427-09-R-0009-0002.pdf | ||
| Additional QandA4.pdf | ||
| Additional QandA3.pdf | ||
| Additional QandA.pdf | ||
| FA4427-09-R-0009 Question and Answer.pdf | ||
| FA4427-09-R-0009 Question and Answer.docx | DOCX document | |
| PWS-7 Aug 09.pdf | ||
| FA4427-09-R-0009-Amendment.pdf | ||
| Past Performance Questionnaire 2.pdf | ||
| Past Performance Request 2.pdf | ||
| FA4427-09-R-0009.pdf | ||
| PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| Performance Work Statement - Inpatient Transcription.pdf | ||
| PAST PERFORMANCE REQUEST.pdf | ||
| 05-2069- WD.pdf |
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Text version
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
REVISED 22 Aug 09
Contractor’s responding to solicitation FA4427-09-R-0009 shall send this Past Performance Questionnaire for their references to fill out.
A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:
“Contractor Name = the contractor responding to the solicitation.”
Contractor’s Name: ____________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________
Project Title and Brief Description of Work: ____________________________________*
Contract Number Provided by Offeror: ___________________ Dollar Amount: ________
In an average six months of performance, please indicate at what threshold the contractor performed in regards to accuracy, within a turn-around-time of 24 hours (4 hours for STAT reports)? Check one below:
____98% or higher ____90%-97% ____85%-89% ____84% or below
Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.
B. RESPONDENT INFORMATION:
“Respondent = Name of the Reference filling out the Questionnaire”
Name of Respondent: _____________________ Title: ____________________________ Facility Name: _____________________
| Address: _____________________ | Telephone Number: ___________________ _____________________________ | Fax Number: | ______________________ |
| _____________________________ | Email Address: ______________________ |
C. FAX or E-MAIL COMPLETED SURVEY FORM TO: PLEASE SEND NO LATER THAN 4:30 PM (PST) 28 Aug 09 to Jessica Pritchett at (707) 424-0288 or jessica.pritchett@travis.af.mil
D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (1, 2, 3, 4, and 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 |
| Limited Confidence |
| No Confidence |
| Unknown Confidence |
| Based on the offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort. |
| Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort. |
| Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort |
| Based on the offeror’s performance record, the government has no expectation that the offeror will successfully perform the required effort |
| No performance record is identifiable or the offeror’s performance record is so sparse that no confidence assessment rating can be reasonably assigned. |
Place an “X” in the appropriate column using the definitions matrix above.
| The contractor: |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 1. |
| Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| 2. |
| Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period. |
| 3. |
| Delegated authority to project managers and supervisors commensurate with contract requirements. |
| 4. |
| Home office participated in solving significant local problems. |
| 5. |
| Followed approved quality control plan. |
| 6. |
| Corrected deficiencies in timely manner and pursuant to their quality control procedures. |
| 6. |
| Identified problems as they occurred. |
| 8. |
| Displayed initiative to solve problems. |
| 9. |
| How would you rate the contractor's overall performance? |
| 10 |
| Would you award another contract to this contractor? If not, explain in “remarks |
| YES/NO |
CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________
Remarks: __________________________________________________________________________________________________________________________________________________________________
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