Attachment 4_Past_Performance_Questionnaire_30 Oct 2026.docx
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- Solicitation number
- HT940827RE003
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire (PPQ) designed for offerors responding to solicitation HT940827RE003 for Nutrition Care Food Service at five Military Medical Treatment Facilities (Forts Irwin, Leonard Wood, Riley, Stewart, and West Point). The form serves as a structured template enabling the Defense Health Agency to evaluate contractor past performance during source selection.
The PPQ operates in two parts: Part 1 is completed by the offeror and captures contractor information including offeror name, whether performing as prime or subcontractor, customer type (commercial, federal government, state government, or other), contract number, award date, completion date, performance period, scope of services, and total contract value. Part 2 is completed by the customer reference and includes administrative verification, confirmation of Part 1 accuracy, and performance ratings across three subfactors: Quality, Schedule, and Management. Each subfactor uses a five-level performance scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, or Not Applicable) with optional comments. Completed and signed PPQs must be submitted as PDF documents with signatures to Contracting Officer Michelle M. Bartkowski (michelle.m.bartkowski.civ@health.mil) and Contract Specialist David Epelding (david.k.erpelding.civ@health.mil) no later than November 4, 2026 at 12:00 p.m. Central Time. Offerors are responsible for initiating the form submission to customer POCs who have first-hand knowledge of performance.
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Nutrition Care Food Service HT940827RE003 Past Performance Questionnaire (PPQ)
Nutrition Care Food Service – Past Performance Questionnaire (PPQ) Attachment 4
Purpose: This PPQ is designed on behalf of the Nutrition Care Food Service Program for use by the Offeror to retrieve past performance data. The Defense Health Agency (DHA) will use the information provided for the Nutrition Care Food Service evaluation.
Offeror Instructions:
1. The Offeror shall complete Part 1 and save.
2. The Offeror shall send the form to the point of contact (POC) for customers to complete Part 2: Performance Evaluation. The customer POC shall be someone with first-hand knowledge of the offeror’s performance or have access to first-hand records.
3. The customer shall complete Part 2, sign Part 2, and save “as a PDF document” with a signature. Alternately, it may be printed and manually signed.
4. The customer shall return to the completed, and signed, PPQ to the Contracting Officer, Michelle M. Bartkowski, michelle.m.bartkowski.civ@health.mil and Contract Specialist, David Epelding, david.k.erpelding.civ@health.mil no later than 4 November 2026 at 1200pm noon Central.
Part 1: (to be completed by the Offeror)
Offeror to complete responses below:
| 1. Offeror |
| Name: |
| 2. Contractor performed as a |
| __ Prime |
__ Subcontractor
| 3. Prime contractor name if different than above |
| Name: |
| 4. Customer identified as |
| __ Commercial |
__ Federal Government __ State Government __ Other:
| 5. Offeror Point of Contact (POC) |
| Name: |
POC Phone Number:
POC Email:
| 6. Contract number |
| #: |
| 7. Contract award date |
| Date: |
| 8. Forecasted or actual contract completion date |
| Date: |
| 9. Performance period being evaluated. |
| Performance Period: |
| 10. The Offeror shall describe the scope of the contract. |
| Provide a general description of services provided: |
| 12. The offeror shall describe the magnitude of the contract. |
| Total Contract Value: $ |
Obligated amount for this specific evaluation period (if different from total contract value): $
End of Part 1.
Part 2: (to be completed by the Reference)
2.1. Administrative.
Reference to complete responses below:
| 1. Customer’s Company/Agency |
| Name: |
| 2. Customer’s Company/Agency |
| Description: |
| 3. Customer Point of Contact |
| Name: |
Job Title:
Email:
Phone Number:
| 4. Please confirm that the contractor’s information provided in “Part 1” is accurate. |
| __ Yes |
__ No. If no, Please provide correction for here incorrect entry here:
2.2. Performance Level Descriptions. Please indicate the performance quality level achieved by the contractor in performance of the tasks listed below based on the performance level descriptions provided.
| Performance Level |
| Performance Level Description |
| Exceptional |
| The contractor’s performance meets contractual requirements and exceeds many requirements to the customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good |
| The contractor’s performance meets contractual requirements and exceeds some requirements to the customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory |
| The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions appear or was satisfactory. |
| Marginal |
| The contractor’s performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contract has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| Unsatisfactory |
| The contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems(s) for which the contractor’s corrective actions appear or were ineffective. |
| Not Applicable |
| Unable to provide a performance level. |
2.3. Quality Evaluation. The customer should rate the offeror’s performance on the above referenced contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable.
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.1. Subfactor 1. Quality. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory __ Not Applicable
Comment:
General Comments (General compliments, problems, and/or corrective actions taken to address the quality of services):
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.2. Subfactor 2. Schedule. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory
General Comments (General compliments, problems, and/or corrective actions taken to address schedule):
Customer should place an “X” on the appropriate qualitative rating. Comments are optional.
| 2.3.3. Subfactor 3. Management. |
| __ Exceptional |
__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory
General Comments (General compliments, problems, and/or corrective actions taken to address the management services):
Customer POC Name:
Date completed:
Customer Signature (Electronic/Physical):
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