Past Performance Questionnaire HT001426QE048.docx
DOCX document 23 KB Posted
- Attached to
- Hospital Communications Support
- Solicitation number
- RFQHT001426QE048
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Questionnaire used by the Defense Health Agency's Healthcare Contracting Division Northeast to evaluate contractor performance on the Hospital Communications Support procurement at Walter Reed National Military Medical Center (WRNMMC), solicitation number RFQHT001426QE048. The questionnaire requests detailed evaluations from references or previous customers of prospective offerors, with responses due by October 26, 2026, at 3:00 PM EDT.
The questionnaire is structured to assess three primary performance categories: Quality of Services (evaluating product/service quality, personnel qualifications, contract management, and quality control processes); Timeliness of Performance/Services (assessing project management, budget tracking, deliverable completion, contractor retention, adherence to schedules, and cost performance); and Business Relations (measuring responsiveness to issues, communication effectiveness, cooperation on solutions, subcontractor management, and complaint resolution). Respondents assign adjectival ratings—High Confidence, Confident, Some Confidence, Low Confidence, Unsatisfactory, or Not Applicable—with mandatory supporting comments for ratings other than satisfactory. The form also requires disclosure of any cure notices, show cause notices, payment suspensions, or terminations for default issued during contract performance, and concludes with an overall rating determination. All responses must include detailed rationale and be signed by the evaluator with contact information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| PWS - HT001426QE048.docx | DOCX document | |
| Solicitation - HT001426QE048 Amendment 1.pdf | ||
| RFQ Document HT001426QE048.docx | DOCX document | |
| Evaluation Factors for Award - HT001426QE048.docx | DOCX document | |
| Solicitation - HT001426QE048.pdf | ||
| Instructions to Offerors HT001426QE048.docx | DOCX document | |
| Hospital Communications Support Pricing Matrix - HT001426QE048.xlsx | XLSX spreadsheet |
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Text version
PAST PERFORMANCE QUESTIONNAIRE HT0014-26-Q-E033
To the Offeror’s Reference:
The Defense Health Agency's Contracting Activity (DHACA), Healthcare Contracting Division Northeast (HCD-NE) is procuring the lease of Hospital Communications Support at Walter National Military Medical Center (WRNMMC). Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important.
Please complete the following questionnaire to assist this office’s evaluation of the Offeror’s past performance. A typed (preferred) or handwritten response is sufficient. If you need more space than that provided, please attach additional pages.
Please provide an adjectival rating for the evaluation questions below and provide comments to substantiate the assigned rating.
Please complete this form no later than October 26, 2026, by 3:00 PM (EDT) and return it 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.
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):
Annual Contract Value
Total 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:
| 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 Subcontractor ________ |
D. RATING INFORMATION:
| RATING |
| DEFINITION |
| High Confidence (H) |
| 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. |
| Confident (C) |
| 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 were effective. |
| Some Confidence (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. |
| Low Confidence (L) |
| 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) How would you rate the quality of the products and services provided by the contractor?
(2) The Contractor provided quality personnel that met or exceeded the required qualifications.
(3) How would you rate the overall management of the contract?
(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 work through a Project Manager for all technical and administrative requirements.
(2) Provide satisfactory project budget tracking for the fabrication and installation phase of the project. Pricing should include all materials, labor and other miscellaneous costs such as travel.
(3) The Contractor consistently provide complete and ready graphic production files, photo shopping images where needed.
(4) The Contractor demonstrated the ability to retain contractors to support contract/task order requirements so that work schedules would not be disrupted.
(5) Assess the timeliness of contractor performance for Services and Product Deliverables: To what extent did the contractor adhere to the delivery schedules, on an overall basis?
(6) How would you rate the contractor’s ability to perform the services within contract costs?
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) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) was apprised of technical and cost issues.
(3) The Contractor cooperated with the Government in providing flexible, proactive, and effective solutions to critical contract issues.
(4) The Contractor provided proactive and effective management of its subcontractors.
(5) 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:
High Confidence ______ Confident _______ Some Confidence ______ Low Confidence ______ Unsatisfactory _______
COMMENTS: (ALL Unsatisfactory, Low Confidence, Some Confidence, or High Confidence 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.
File details come from the government source that posted it. Updated .