Attachment 3 - Past Performance Questionnaire .docx
DOCX document 26 KB Posted
- Attached to
- Naval Hospital Bremerton-Branch Health Clinic Everett Medical Linen Rental and Laundry Service
- Solicitation number
- HT941027Q0004
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire (PPQ) template used by the Defense Health Agency's Western Markets Contracting Division to evaluate contractor performance for potential federal contract awards. The form is designed to gather feedback from previous clients or government agencies regarding an offeror's performance on past projects, with responses to be submitted no later than 11:00 AM Pacific on November 18, 2026, to angelinemae.m.santiago.civ@health.mil or jasmin.m.rooker.civ@health.mil.
The PPQ evaluates contractors across 19 assessment areas using a standardized five-point rating scale (Exceptional, Very Good, Satisfactory, Marginal, or Unacceptable, with a Not Applicable option). Key evaluation categories include client relationship management, subcontractor coordination, employee hiring and retention, corporate integrity, work quality, quality control, schedule performance, cost control, labor and safety compliance, and documentation timeliness. The form also includes yes/no questions regarding cure notices, problem resolution capability, contract award willingness, customer satisfaction, and opportunities for contractor response to negative comments. Evaluators must provide their name, organization, contact information, position, and signature, and the Government reserves the right to verify all information provided. If the referenced project is a Government project, evaluators may submit an official performance evaluation in lieu of completing the full questionnaire.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment 2- WD 2015-5535 Rev30.pdf | ||
| CSS HT941027Q0004 (Everett Linen and Laundry).pdf | ||
| Exhibit A-F - Price Worksheet.xlsx | XLSX spreadsheet | |
| Attachment 1- Everett _Medical Linen Rental and Laundry Service SOW.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 3
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 both angelinemae.m.santiago.civ@health.mil and jasmin.m.rooker.civ@health.mil no later than 11:00AM Pacific on 18 November 2026. 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 .