Revised-Attachment 3 HT001426RE001 Past Performance Questionnaire.docx
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- Solicitation number
- HT001426RE001
- Issued by
-
Defense Health Agency
About this file
This document is a Past Performance Questionnaire for Solicitation Number HT001426RE001, issued by the Defense Health Agency Contracting Activity (DHACA) for the Traumatic Brain Injury Center of Excellence (TBICoE) Warfighter Brain Health Research and Translation Support Services. The solicitation seeks nonpersonal and personal services for approximately 74.25 full-time equivalent employees across 43 distinct labor categories, including roles such as Program Manager, Medical Writer/Editor, TBI Subject Matter Experts, Research Scientists, Epidemiologists, and various clinical and administrative positions.
The questionnaire is designed to evaluate a contractor's past performance across three primary areas: Quality of Services, Timeliness of Performance/Services, and Business Relations. Ratings range from Unsatisfactory to Exceptional, with specific criteria for each performance dimension. The contract supports TBICoE's mission of advancing traumatic brain injury research, clinical standards, and knowledge translation for warfighter brain health, with subject matter experts embedded across Defense Health Agency facilities. The solicitation involves supporting DoD medical personnel, service members, veterans with TBI, and their families through comprehensive research, surveillance, clinical tool development, and education/training initiatives.
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Text version
PAST PERFORMANCE QUESTIONNAIRE RFP HT001426RE001
The Defense Health Agency Contracting Activity (DHACA), Healthcare Contracting Division - Northeast (HCD – NE) is conducting an acquisition for Traumatic Brain Injury Center of Excellence (TBICoE) Warfighter Brain Health Research and Translation Support Services. The offeror has identified you as a reference to validate past performance.
Solicitation Number HT001426RE001 is for nonpersonal and personal services of approximately 74.25 FTEs divided among 43 different labor categories as specified in the Performance Work Statement: Program Manager; Deputy Program Manager HQ; Medical Writer/Editor; Business Operations Administrator; Communication Manager; Communications Specialist; Graphic Designer; Management Support Specialist; Administrative Assistant; Brain Injury and Health Project Manager; TBI Subject Matter Expert (SME) Physician (CPCR); TBI SME Midlevel Provider (CPCR); TBI SME Scientist (CPCR); TBI SME Behavioral Health (CPCR); Neuroscience Clinician (CPCR); Program Analyst (Clinical Affairs); Program Analyst (TBI Outcomes); Senior Biostatistician (Outcomes); Health Systems Specialist (Outcomes); Senior Surveillance Analyst; Epidemiologist (Surveillance); Surveillance Analyst; Network Dissemination Manager; Network Dissemination Coordinator (NDC); Dissemination & Implementation (D&I) Specialist; Research Scientist (D&I); Project Analyst (D&I); Dissemination Projects Manager; Neuroscience Clinician (Dissemination); Instructional Systems Specialist; TBI Research Activities Manager; Senior Clinical Research Director; Research Neuropsychologist/Neuroscientist; Research Scientist; Clinical Research Coordinator; Research Psychometrist; Research Data Associate; Research Associate; Research Assistant; Epidemiologist (Research); Senior Statistical Data Analyst; Senior Research Program Analyst; and Research Project Analyst.
Please complete the following questionnaire to assist our evaluation of the Contractor’s past performance, and return via email no later than (Contractor provide date and time) to the company that provided it to you for their submission to this DHA Contracting Office.
Thank you for your assistance in this source selection. If you have any questions, please contact John A. Cowgill, Sr. Contract Analyst, john.a.cowgill4.ctr@health.mil ; Sou J. Walls, Contracting Officer, sou.j.walls.civ@health.mil ; or Gregory M. Crump, Contract Specialist, gregory.m.crump.civ@health.mil .
A. EVALUATED CONTRACTOR’S INFORMATION:
Company/Organization Name being evaluated:
Cage Code:
Point of Contact (POC):
Title of POC:
Address:
Telephone Number:
Email address:
B. CONTRACT INFORMATION:
Contract Title/Description:
Contract Number:
Task Order Number (if Applicable):
Status (i.e. On-going, complete):
Contract Amount: (Total amount of base period of performance plus any option period(s) exercised to date)
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
| Was work with a: |
| Commercial_____ Fed Gov’t_____ Local/State Gov’t_____ entity. |
C. CONTRACTING OFFICER REPRESENTATIVE INFORMATION:
COR’s Name:
Telephone Number:
Email:
| Evaluated Contractor Performed as: |
| Prime Contractor _______ or Sub Contractor ________ |
D. RATING INFORMATION:
| RATING |
| DEFINITION |
| 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. |
| N/A |
| Not applicable to the subject contract or requirement |
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.
Please provide a rationale for your Quality of Services Rating (required for other than satisfactory 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 on time to meet the Government’s needs.
(4) The Contractor demonstrated the ability to retain 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.
Please provide a rationale for your Timeliness of Performance/Services Rating (required for other than satisfactory 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.
Please provide a rationale for your Business Relations Rating (required for other than satisfactory rating): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
F. OTHER:
(1) 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. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(2) Based upon the information you provided and using the definitions provided in the evaluation criteria above, please provide your Overall Rating:
Exceptional ______ Very Good ______ Satisfactory ______ Marginal ______ Unsatisfactory ______
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: _________________________________________ Date: __________________
Print Name: _________________________________________
Title: _______________________________________________
Telephone: __________________________________________
Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.
As of 19 Feb 25
File details come from the government source that posted it. Updated .