Past Performance Questionnaire..pdf
PDF 160 KB Posted
- Solicitation number
- W81K0022Q0163
- Issued by
-
Department of the Army Medical Command
About this file
This document contains a past performance questionnaire for a contractor providing environmental compliance and industrial hygienist services. The Regional Health Contracting Office - Central is soliciting these services in support of the environmental health, compliance, industrial hygiene, and occupational health programs at Brooke Army Medical Center. The past performance questionnaire seeks information about a named contractor's performance on contracts over the past three years for quality of service, compliance with statements of work, management of business relations, flexibility, and concern for the customer. Responses to the questionnaire are due by August 19, 2022 and should be sent to the points of contact listed. The services solicited under opportunity number W81K0022Q0163 include environmental compliance and industrial hygienist services to support the programs at Brooke Army Medical Center. The contracting agency is the Department of the Army Medical Command.
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Other files
| File | Type | Posted |
|---|---|---|
| W81K00-22-Q-0163.pdf | ||
| ATTACHMENT 1 - Sample Compensation Plan.docx | DOCX document |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
W81K00-22-Q-0163
San Antonio Military Medical Center, Fort Sam Houston, Texas
The Regional Health Contracting Office – Central is conducting an acquisition for Industrial Hygienist & Environmental Specialist Services. The offeror has identified you as a reference to validate the offeror’s past performance.
Please complete the following questionnaire to assist our evaluation of the contractor’s past performance and return to: Gerri Hernandez at geraldine.i.hernandez.civ@mail.mil NLT 19 August 2022 at 10:00 AM CST.
1. Name of vendor being evaluated: ___________________________________________________________
2. How long has your company had a contract with this vendor? _____________________________________
3. What type of services are provided? _________________________________________________________
4. What is the location of this service? _________________________________________________________
5. What is the contract number? ______________________________________________________________
6. What is the total contract value? ____________________________________________________________
7. Have any reports/schedules submittals been provided as required by the contract? _____________________
If not, provide a brief explanation: _____________________________________________________________
8. Have there been late deliveries or other unsatisfactory performance resulting in additional contractual or administrative costs?
Yes _______ No _______
If yes, please explain:
mailto:robyn.a.villafranco.civ@mail.mil mailto:caesar.trevino.civ@mail.mil
The following questions should be answered using the following definitions:
ADJECTIVE DEFINITION AND CRITERIA
Acceptable Based on the offeror’s performance record, there is a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown.
Unacceptable Based on the offeror’s performance record, there is no reasonable expectation that the offeror will be able to successfully perform the required effort.
9. Quality of Service: Compliance with contract statement of work requirement.
Acceptable ___ Unacceptable ___
Additional Information:
10. Business/Customer Relations: Successfully managed services; reasonable/cooperative behavior; flexible;
business-like concern for customer’s interest.
Acceptable ___ Unacceptable ___
Additional Information:
Signature: _______________________ Date: _____________________________
Print Name: ______________________ Company: _________________________
Title: ___________________________ Telephone: _________________________
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