HT001125R0011 Atch B Past Performance Questionnaire.docx
DOCX document 42 KB Posted
- Attached to
- Primary Care Behavioral Health Expert Trainers
- Solicitation number
- HT001125R0011
- Issued by
-
Defense Health Agency
About this file
The document is a Past Performance Questionnaire for solicitation HT001125R0011, designed to capture detailed performance evaluations of a contractor. The questionnaire provides a comprehensive rating scale from Poor/Unsatisfactory to Excellent, allowing evaluators to assess six key performance areas including delivery schedule compliance, business practices, contract requirement adherence, terms and conditions compliance, customer satisfaction, and overall performance. Evaluators are asked to rate each area using abbreviations (P/U, S, G, VG, E, N) and provide comments, with a final question asking whether the evaluator would purchase services from the contractor again.
The questionnaire is specifically linked to a Defense Health Agency solicitation for Primary Care Behavioral Health Expert Trainers, which is an 8(a) set-aside procurement seeking a single Firm Fixed-Price contract for 60 months. The contract aims to provide installation-level training support for Primary Care Behavioral Health (PCBH) clinical processes, requiring psychologist Subject Matter Experts to develop and deliver trainings, mentor Behavioral Health Consultants, support Military Treatment Facility implementations, and support care delivery models. Services will be delivered remotely from locations throughout the United States, with questions due by March 17th, 2025, at 4:00 pm.
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Text version
HT 001125 R 0011, Attachment B
PRESENT AND PERFORMANCE QUESTIONNAIRE
Offeror’s/Bidder’s Name (Company/Division): Reference Information TableBusiness Name of Reference & Address
Point of Contact
Phone number
E-mail address
Contract Number
Type
Contract Value
a. Original
b. Value at Completion
c. Reason for any Changes
Period of Performance
a. Date Completed/To Be Completed
b. Reason for Any Change
Description of Effort
HT 001125 R 0011, Attachment B
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
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