Attch 7 PPQ POST W NEW AMENDMENT.docx
DOCX document 20 KB Posted
- Solicitation number
- HT001421R0004
- Issued by
-
Defense Health Agency
About this file
This document contains a past performance questionnaire and details of a federal solicitation. The past performance questionnaire is to be completed by a reference for a contractor proposing for the Integrated Referral Management and Appointing Center Call Center Support Services solicitation. The solicitation is seeking call center support services for the Defense Health Agency's Integrated Referral Management and Appointing Center National Capital Market Consolidated Call Center located in Bethesda, Maryland. Services include providing personnel to support referral management, with staff potentially located at military treatment facilities across the National Capital Region or authorized telework locations. The completed questionnaire is due by the specified date and must be sent directly to the Defense Health Agency points of contact via email. The questionnaire includes rating scales to evaluate the contractor's performance quality, timeliness, and business relations on previous relevant contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| Price and Compensation Matrix.xls | XLS spreadsheet | |
| HT001421R00040001.pdf | ||
| DMCD TASS Application - IRMAC 12 Oct 21.xls | XLS spreadsheet | |
| CAC Request Process - IRMAC 12 Oct 21.pdf | ||
| CDRL A001 Quality Plan.pdf | ||
| Price and Compensation Matrix HT001421R0004.xls | XLS spreadsheet | |
| CDRL A002 Monthly Report.pdf | ||
| HT001421R0004.pdf |
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Text version
QUESTIONNAIRE COVER LETTER
(NOTE: This information should be on company letterhead.)
| TO: | QUESTIONNAIRE EVALUATOR | DATE OF LETTER |
| AGENCY OR ORGANIZATION NAME | ||
| STREET ADDRESS | ||
| CITY/STATE/ZIP CODE |
| FROM: | COMPANY NAME (CAGE CODE) | |
| STREET ADDRESS | ||
| CITY/STATE/ZIP |
SUBJECT: Past Performance Questionnaire for (contract title) concerning contract numbers (contract/TO number(s)).
1. Our company is currently preparing to submit our proposal, in response to the solicitation for Integrated Referral Management and Appointing Center (IRMAC) services under solicitation number HT001421R0004. In doing so, providing relevant past performance experience is required as part of our proposal submission.
1. We have identified the above referenced contract(s) as relevant to this acquisition and you as our point of contact (POC). As such, we request that you complete the attached Past Performance Questionnaire, by providing responses to questions and adding comments regarding our performance.
1. Upon completion, please forward the questionnaire directly to Mr. John A. Cowgill and Mrs. Fa’atalivale Te’o-Lewis, via respective e-mails: john.a.cowgill4.ctr@mail.mil and faatalivale.m.teo-lewis.civ@mail.mil . DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO US. The information provided by you regarding our performance is considered sensitive and cannot be released to us or submitted to Ms. Te’o-Lewis or Mr. Cowgill by us. Please ensure the subject line of your e-mail includes the following information in the subject line so the e-mail is not misconstrued as SPAM or otherwise deleted: Past Performance Questionnaire HT001421R0004.
4. The completed questionnaire should be received by Mrs. Te’o-Lewis and Mr. Cowgill not later than (Date to be inserted by offeror, prior to the due date). If you have any questions regarding the requirement or the completion and submission of the questionnaire, please contact Mr. Cowgill, Senior Contract Analyst (Amyx, Inc.), via e-mail at john.a.cowgill4.ctr@mail.mil.
5. If you have questions for our company please contact (contractor’s POC and phone number for past performance issues). Thank you for your timely response.
PAST PERFORMANCE QUESTIONNAIRE
Please provide your candid responses. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Thank you.
RETURN COMPLETED SURVEY FORM TO:
Defense Health Agency (DHA) Deputy Assistant Director – Pricing and Contracting Solicitation Number: HT001421R0004 Phone Number: 703-275-6345 E-mail: john.a.cowgill4.ctr@mail.mil
A. EVALUATED CONTRACTOR’S INFORMATION: (To be completed by the Offeror)
Company/Organization Name being evaluated
Cage Code:
Point of Contact (POC):
Title of POC:
Address:
Telephone Number:
B. CONTRACT INFORMATION: (To be completed by the Offeror)
Contract Title/Description:
Contract Number:
Task Order Number if Applicable
Status (i.e. On-going, complete):
Contract Amount: total amount of base plus any options
Type of Contract
Performance Period being evaluated
Place of Performance:
Total Number of FTEs
Title of Position(s) provided by the Offeror
| Was work with a: |
| Commercial_____ Fed Gov’t_____ Local/State Gov’t_____ entity. |
C. RESPONDENT INFORMATION:
Respondent’s Name:
Respondent’s Title
Company/Organization Name
Address:
Telephone Number:
| Evaluated Contractor Performed as: |
| Prime Contractor _______ or Sub Contractor ________ |
D. RATING INFORMATION:
Choose the number on the scale of 0 to 5 that most accurately describes the Offeror’s performance or situation. If you are unable to rate a question because it was not a requirement or you have no knowledge of the contractor’s performance under the question situation, then you should mark “Not Applicable” and do not include the specific question in the total number of questions answered at the bottom of the applicable section. If the question situation would be considered a part of the required performance under this contract, but the contractor have experience in the area, then mark “0” and include it in the total number answered at the bottom of the applicable section.
| RATING |
| DEFINITION |
| Exceptional = 5 |
| Performance meets contractual requirements and exceeds many requirements to the government’s benefit. (Risk Level: Very Low) |
| Very Good = 4 |
| Performance meets contractual requirements and exceeds some to the government’s benefit. (Risk Level: Low) |
| Satisfactory = 3 |
| Performance meets contractual requirements. (Risk Level: Moderate) |
| Marginal = 2 |
| Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet implemented satisfactory corrective action. (Risk Level: High) |
| Unsatisfactory = 1 |
| Performance does not meet contractual requirements recovery is not likely in a timely manner. Contractor’s corrective actions to date are ineffective (Risk Level: Very High) |
| Unknown = 0 |
| The Offeror has little/no relevant past performance upon which to base a meaningful performance risk prediction. (Risk Level: Unknown) |
E. 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.
(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.
Performance Rating Total
Performance Rating Total Divided by total number of questions answered
Overall Rating
Timeliness of Performance/Services
Performance Rating
(1) The Contractor successfully achieved fill-rates established by the contract.
(2) The labor turnover in personnel and other labor categories (to include contracted health care providers) was minimal and did not adversely affect Contractor Performance.
(3) The Contractor consistently demonstrated an ability to quickly recruit HCPs on time to meet the Government’s needs.
(4) The Contractor demonstrated the ability to retain HCPs to support contract/task order requirements so that work schedules would not be disrupted.
(5) 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.
(6) Credentialing Packages (to include current and complete information) were presented in timely fashion to the applicable facility.
Performance Rating Total
Performance Rating Total Divided by total number of questions answered
Overall Rating
Business Relations
Performance Rating
(1) The Contractor had the ability to respond effectively to contract performance issues.
(2) If applicable, the Contractor acted in accordance with any “Non-Compete Clause” 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.
(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.
Performance Rating Total
Performance Rating Total Divided by total number of questions answered
Overall Rating
F. OTHER:
(1) Would you award this firm another contract? ( ) Yes, ( ) No. If you answered “No” provide an explanation. ________________________________________________________________________________________________________________________________________________________________________________________
(2) 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. ________________________________________________________________________________________________________________________________________________________________________________________
(3) Based upon the information you provided and using the definitions provided in the evaluation criteria above, please select the overall performance rating for this Contractor.
Exceptional ______ Very Good ______ Satisfactory ______ Marginal ______ Unsatisfactory ______ Unknown ______
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 will not be evaluated by the Government): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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