HT001125R0001 Atch B Past Performance Questionnaire.docx
DOCX document 32 KB Posted
- Attached to
- Health Care Operations and Other Program Management Support Federal contract opportunity
- Solicitation number
- HT001125R0001
- Issued by
- Defense Health Agency
About this file
This is a Past Performance Questionnaire template (Attachment B) for solicitation HT001125R0001. The questionnaire is designed to evaluate contractor performance across six key areas using a rating scale from Poor/Unsatisfactory to Excellent, plus a Neutral option.
The evaluation criteria include compliance with delivery schedules, business practices, conformance to contract requirements, overall contract compliance, cooperative behavior and customer satisfaction, and overall performance. The form requires reference information including contract numbers, values, periods of performance, and points of contact. Completed questionnaires are to be returned to specified DHA email addresses. The template is a standard evaluation form and does not contain specific requirements or objectives for the healthcare operations support services being solicited.
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Text version
HT
R
Attachment
B 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 vicki.l.whiteman.civ@health.mil and john.j.kelley36.ctr@health.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
File details come from the government source that posted it. Updated .