HT001120R0003 Atch B Past Performance Questionnaire.docx

DOCX document 28 KB Posted

Attached to
Disability Evalution System Program Support Federal contract opportunity
Solicitation number
HT001120R0003
Issued by
Defense Health Agency

About this file

This document contains a past performance questionnaire and details of a solicitation for disability evaluation system program support services. The past performance questionnaire is to be completed by references for the offeror and includes ratings questions on delivery schedule compliance, business practices, record of conforming to requirements, compliance with terms and conditions, commitment to customer satisfaction, and overall performance. It also asks if the reference would purchase services from the contractor again.

The solicitation is set aside for small businesses and seeks proposals for services supporting the Defense Health Agency in policy and program development and oversight of the Disability Evaluation System, Special Compensation for Assistance with Activities of Daily Living, Physical Disability Board of Review, and Compensation and Benefits Handbook. The contract will also provide administrative and records management support to the DHA office in Arlington, Virginia. Proposals are due by the date and time specified and must include an organizational conflict of interest mitigation plan. The solicitation utilizes FAR Part 15 procedures and seeks to mature existing programs through continuous improvement.

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Text version

HT

R

Attachment

AB

Page of

PRESENT AND PERFORMANCE QUESTIONNAIRE

Business

Name of

Reference

Address Point of

Contact Phone number E-mail address Contract

Number Type Contract

Value Original Value at Completion Reason for any

Changes Period of

Performance Date Completed/To

Be

Completed Reason for Any

Change Description of

Effort )Offeror’s/Bidder’s Name (Company/Division): Reference Information Table

HT

R

Attachment

B Page of

Evaluation KEY: Please use the following abbreviations to assign an applicable rating for questions 1 thru 6 below:

P/U
S
G
VG
E
N
Poor Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Neutral
Does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas; deficiencies in one or more areas, which adversely affect overall performance.
Meets or slightly exceeds minimum acceptable standards; adequate results; reportable deficiencies with identifiable, but not substantial, effects on overall performance.
Effective performance; fully responsive to contract requirements; reportable deficiencies, but with little identifiable effect on overall performance.
Very effective performance; fully responsive to contract requirements; contract requirements accomplished in a timely, efficient, and economical manner for the most part; only minor deficiencies with minimal effect on overall performance
Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall performance
No record of relevant past performance or past performance information is not available

Return completed surveys to rob.e.leblanc6.civ@mail.mil and john.j.kelley36.ctr@mail.mil.

1. How would you rate the contractor’s compliance with the delivery schedule / performance milestones?

Comments:

P/U |_| S |_| G |_| VG|_| E |_|

N |_|

2. How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?

Comments:

P/U |_| S |_| G |_| VG|_| E |_|

N |_|

3. How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service/timeliness of performance/report submission?

Comments:

P/U |_| S |_| G |_| VG|_| E |_|

N |_|

4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

Comments:

P/U |_| S |_| G |_| VG|_| E |_|

N |_|

5. How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?

Comments:

P/U |_| S |_| G |_| VG|_| E |_|

6. How would you rate the contractor’s overall performance? Comments:

P/U |_| S |_| G |_| VG|_| E |_|

7. Would you purchase services from this contractor again? Comments:

YES |_| NO |_|

EVALUATOR NAME/TITLE

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