Attachment D_HT0011-R-25-0020 RHRP4 PPQV2.docx

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

EVALUATED CONTRACTOR’S INFORMATION: To the Offeror’s Reference:

The Defense Health Agency's (DHA) Program Management Office-Enterprise Medical Services (PMO-EMS) and PMO-Reserve Health Readiness Program is conducting an acquisition to obtain medical and dental readiness services to the military Service Components (SCs) of the Reserve Components (RCs), Active Components (ACs) enrolled in TRICARE Prime Remote (TPR), DoD Service Civilians, and members of the Department of Homeland Security (DHS). The Offeror has identified you/r office as a reference to validate the Offeror's past performance.

Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important.

Please complete the following questionnaire to assist this office’s evaluation of the Offeror’s past performance. A typed (preferred) or handwritten response is sufficient. If you need more space than that provided, please attach additional pages.

Please complete this form no later than May 9, 2025 by 4:00 PM (EST) and “Do Not” return the past performance questionnaire to the company that requested it; send it directly to the DHA NCR Healthcare Ops Mailbox RHRP <dha.ncr.healthcare-ops.mbx.rhrp@health.mil> Thank you for your assistance in this source selection. If you have any questions, please contact Nakaura Yusuf, Contracting Officer at (703) 681-5821.

Company/Organization Name being evaluated:

Cage Code:

Point of Contact (POC):

Title of POC:

Address:

Telephone Number:

Email address:

CONTRACT INFORMATION:

Contract Title/Description:

Contract Number:

Task Order Number (if Applicable):

Status (i.e. On-going, complete):

Annual Contract Value:

Defense Health Agency (DHA) Remote Health Readiness Program-4

Contract Amount: (Base plus options)

Type of Contract (e.g. FFP, Cost, etc.):

Performance Period being evaluated:

Place of Performance:

Total Number of Full Time Employees employed:

Title of Position(s) provided by the Offeror

entity.

CONTRACT EVALUATOR INFORMATION:

Evaluator’s Name:

Telephone Number:

Email:

RATING INFORMATION:

Exceptional (E) Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good (VG) Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

Satisfactory (S) Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal (M) Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory (U) Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

PERFORMANCE EVALUATION QUESTIONS:

Quality of Services Performance Rating

(1) The Contractor provided quality services that adhered to contract requirements, specifications, and standards of professional conduct. The deliverables were determined to be acceptable to the client.

(2) The Contractor provided quality personnel that met or exceeded the required qualifications.

(3) The Contractor demonstrated an overall effective and quality management effort.

(4) The Contractor maintained an effective on-going Quality Control Plan to provide for monitoring, analyzing, and improving quality contract performance.

Please provide specific examples and rationale for your Quality of Services Rating (required for other than satisfactory rating):

Timeliness of Performance/Services

(1) The Contractor completed all tasks and submitted required deliverables in accordance with the timelines and were accepted by the recipient.

(2) The Contractor successfully achieved fill-rates established by the contract.

(3) The labor turnover in personnel and other labor categories was minimal and did not adversely affect Contractor Performance.

(4) The Contractor consistently demonstrated an ability to quickly recruit personnel on time to meet the Government’s needs.

(5) The Contractor demonstrated the ability to retain personnel to support contract/task order requirements so that work schedules would not be disrupted.

(6) The Contractor demonstrated the ability to plan for and provide replacement candidates to include pre-planned absences, unplanned illnesses, or an extended leave of absence.

Please provide specific examples and rationale for your Timeliness of Performance/Services Rating (required for other than satisfactory rating):

Business Relations

(1) If applicable, the Contractor was proactive and communicated potential contract performance issues with the Customer.

(2) If applicable, the Contractor acted in accordance with any Terms and Conditions of the contract.

(3) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) was apprised of technical and cost issues. Contractor submitted recurring status updates on their activities.

(4) The Contractor cooperated with the Government in providing flexible, proactive, and effective solutions to critical contract issues.

(5) The Contractor provided proactive and effective management of its subcontractors.

(6) The Contractor was able to resolve customer complaints quickly and effectively.

Please provide specific examples and rationale for your Business Relations Rating (required for other than satisfactory rating):

Compliance with Subcontracting Plan:

Did the contractor submit a Subcontracting Plan as required by the contract? Yes______ No______ NA_____

Were the agreed-upon small business participation goals met? Yes_____ No_____ NA____

If goals were NOT MET, did the contractor provide a valid reason (e.g., lack of qualified small business sources, changes in contract scope)?

Were any corrective actions taken to improve small business participation?

Summary: _______________________________________________________________________________________

OTHER:

Was a cure notice ; show cause notice ; suspension of progress payments, and/or termination for default issued to this firm during performance of this contract? If you answered “Yes”, provide an explanation.

Based upon the information you provided and using the definitions provided in the evaluation criteria above, please provide your Overall Rating:

COMMENTS: (ALL Unsatisfactory, Marginal, Very Good, or Exceptional Ratings require comments to support the same. Failure to provide comments may render the questionnaire void and may result in it in not being evaluated by the Government):

Signature of Evaluator:

(Digital CAC signature if possible)

Typed Name

Title:

Date:

THANK YOU for your support of the Defense Health Agency's (DHA) Remote Health Readiness Program

I appreciate your valuable time and assistance with this important acquisition!