Attachment 4 - Past Performance Questionnaire (PPQ) - Amended.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Travis AFB is in the process of soliciting offers from companies capable of providing:

MFT 21-17 Sterilizer Equipment Maintenance services to support David Grant Medical Center

In order for 60th Contracting Squadron to conduct its evaluation, we request that you have a previous client/customer complete the full questionnaire below and email a PDF file to:

un.pak.2@us.af.mil, Contract Specialist, at 60 CONS, Travis AFB. The due date for completed questionnaires is: 4 September 2020 at 1:00 PM Pacific Standard Time. The completed questionnaire will become part of the official source selection records. To be considered, the Past Performance Questionnaire needs to 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: 1st Lt Un Y. Pak by email at un.pak.2@us.af.mil, Tel: 707-424-7754.

A. OFFEROR’s REFERENCE INFORMATION:

Contract Name and/or Number (Include task order number(s) if applicable:

Company (Include task order number(s) if applicable:

Address:

POC of Contact (POC):

Title of POC:

Telephone Number:

Email:

Contractor performed as: Prime Contractor ____ Sub-Contractor ____

Attachment 5 - List of References Task Order Proposal Request: FA4427-20-R-0028 mailto:mena.mederios@us.af.mil mailto:nixie.mistri.1@us.af.mil

B. RESPONDENT INFORMATION: Please complete

Contracting Activity/Customer:

Address:

Telephone Number:

Email Address:

Point of Contract (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) Annual Contract Value:

Total Contract Dollar Value: (base plus options) Number of FTEs Contract Description:

Contractor performed as: Prime Contractor: _____ Sub-Contractor: _____

If subContractor: What percentage was performed by the evaluated Contractor

A. PERFORMANCE INFORMATION: Choose the appropriate number 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

Neutral Confidence

Limited Confidence

No Confidence

Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.

Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.

No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

The offeror may not be evaluated favorably or unfavorably on the factor of past performance.

Based on the offeror’s recent/relevant performance record, the Government has a low expectation that the offeror will successfully perform the required effort.

Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.

Place an “X” in the appropriate column using the definitions matrix above.

THE CONTRACTOR 1 2 3 4 5

1 The Contractor provided quality service that adhered to contract requirements.

2 The Contractor consistently responded to problems and took appropriate action to correct performance.

3 Did the contract involved hard to fill positions (specialty positions) or positions in high cost of living areas? If so, did Contractor successfully recruit and retain qualified contracted medical personnel with minimal disruption?

4 Contractor corrected deficiencies in timely manner and pursuant to their contract requirements.

5 Contractor demonstrated an overall effective and quality management effort.

6 Contractor cooperated with the Government in providing flexible, proactive and effective solutions to critical contract issues.

THE CONTRACTOR 1 2 3 4 5

7 Contractor demonstrated ability to plan for and provide replacement candidates during the life of the contract to include preplanned absences, unplanned illnesses, or an extended leave of absence.

8 Contractor consistently demonstrated an ability to quickly recruit and retain qualified medical contract personnel in accordance with the contract requirements to avoid disruption of services and/or work schedule.

9 Credentialing packages (to include current and complete information) were presented in timely to the applicable Credentialing office?

10 How would you rate the Contractor’s overall performance

Yes No

Is the Contractor rated in CPARS?

12 Was the Contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

13 Would you award another contract to this Contractor? If not, explain in “remarks.”

Additional Remarks