Attachment 2 - Past Performance Questionnaire.docx

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Attached to
Service and Preventative Maintenance for STERIS Equipment at Naval Health Clinic Lemoore and Dental
Solicitation number
HT941023Q2016
Issued by

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This document contains a past performance questionnaire template to be completed by references for an offeror bidding on a federal contract opportunity. The opportunity is for service and preventative maintenance for STERIS equipment at Naval Health Clinic Lemoore and Dental. The past performance questionnaire requests ratings and comments on the offeror's performance on previous similar contracts. It covers aspects such as relationship with the customer's contract team, management of subcontractors, ability to hire and retain qualified employees, overall management and conduct, quality of work, ability to meet schedules and control costs, and compliance with various standards. References are asked to provide an overall rating for the offeror being evaluated. The federal contract opportunity is solicitation number HT941023Q2016 issued by the Defense Health Agency to maintain STERIS equipment at specified Naval health facilities.

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Attachment 3 - Quote Sheet.xlsx XLSX spreadsheet
Combined Synopsis - STERIS Equipment v2.pdf PDF
Combined Synopsis - STERIS Equipment.pdf PDF
SOW -Redacted.pdf PDF

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Attachment 2

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Defense Health Agency (DHA) Western Markets Contracting Division is considering the Offeror listed below for a U.S. Government contract. Your comments would be appreciated regarding this firm’s past performance. After completing this PPQ, you are highly encouraged to send it back to the Offeror to be submitted with their quote. However, you may return it directly to this office via email to no later than [Insert Quote Due Date]. Your prompt response is greatly appreciated. If the referenced project is a Government project, you may forward a copy of the official performance evaluation in lieu of completing this form. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

Offeror Information

Name of Offeror Being Evaluated:

Address of Offeror Being Evaluated:

Project Information

Contract Number:

Delivery/Task Order Number:

Contract/Project Title:

Location:

Award Date:

Completion Date:

Contract Value:

Offeror Performed As:
|_| Prime Contractor |_| Sub-Contractor

Description of Work Performed:

Evaluator Information

Name of Evaluator:

Government Agency/Commercial Company:

Address:

Phone Number:

Email Address:

Position Held in Relation to this Project:

Rating: Please evaluate the past performance using only the following ratings without variation.

DO NOT RATE ON A “+” OR “-” SCALE. If a “+” or “-” is used, the rating without the “+” or “-” will be applied. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.

“E”
Exceptional
Performance greatly exceeded the contract requirements.
“VG”
Very Good
Performance exceeded the contract requirements.
“S”
Satisfactory
Performance met the contract requirements.
“M”
Marginal
Performance met the minimum contract requirements, but some material aspects of the contractor’s performance were less than satisfactory.
“U”
Unacceptable
Performance was poor and/or did not satisfy contract requirements.
“NA”
Not Applicable
No information or did not apply to your contract.

Please rate and provide any supporting information/comments for the following:

1. The relationship between the Offeror and client’s/customer’s contract team:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

2. The Offeror’s management and coordination of subcontractors:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

3. Ability/actions to hire and retain a sufficient number of qualified employees for the performance of the contract work:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

4. Overall corporate management, integrity, reasonableness, and cooperative conduct:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

5. Quality of work:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

6. Quality control:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

7. Ability to meet the performance schedule:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

8. Ability/actions to improve schedule problems, if applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

9. Ability to control costs and provide the required work at a reasonable total price:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

10. Compliance with labor standards, as applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

11. Compliance with safety standards and/or number of safety related incidents, code compliance, as applicable:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

12. Ability to submit required documentation (work schedule, reports, data, etc.) in a timely manner:
|_| |_| |_| |_| |_| |_|

E VG S M U NA

13. Have any cure notices, show cause letters, letter of reprimand, suspension of payment, or termination been issued? If yes, please explain:
|_| |_|

Yes No

14. Was the contractor able to solve contract performance problems without extensive guidance from your procurement or technical personnel? If no, please explain:
|_| |_|

Yes No

15. Would you award another contract to the party being evaluated? If no, please explain:
|_| |_|

Yes No

16. Was the customer satisfied with the end product? If no, please explain:
|_| |_|

Yes No

17. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results?
|_| |_| |_|

Yes No NA

18. Additional Remarks:

19. Overall rating for this firm:
|_| |_| |_| |_| |_|

E VG S M U

Signature of Evaluator Date

PLEASE NOTE: Contractors may be advised of adverse remarks and given the opportunity to respond in accordance with Federal Acquisition Regulation (FAR) requirements. However, in accordance with FAR 15.306(e)(4), the names of individuals providing reference information about an Offeror’s past performance shall not be disclosed.

Past Performance Questionnaire, Page 1 of 3 (Rev 11/2022)

File details come from the government source that posted it. Updated .