PSAS Past Performance Questionnaire 1 (003).docx

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

Please complete the following questionnaire to assist our evaluation of the Contractor’s past performance, and return via email no later than March 23 at 1:00pm EST to Paul Desilets, paul.h.desilets.ctr@mail.mil and Linda Walker, linda.m.walker38.civ@mail.mil.

RESPONDENT INFORMATION:

Contracting Activity/Customer:

Point of Contact (POC):

Title of POC:

Telephone:

Email:

OFFEROR’S REFERENCE INFORMATION:

Contractor Name:

Point of Contact (POC):

Telephone Number:

Email:

CONTRACT INFORMATION:

Contract Number:

Task Order Number:

Type of Contract:

Performance Period: (Base plus any options):

Description of Services:

MARKET SEGMENT

MAGNITUDE

Annual Contract Value:

Total Contract Dollar Value:

COMPLEXITY

Number of FTEs:

Contractor performed on this contract as:

Please refer to the following assessment definitions to assess the Contractor’s performance in each of the areas listed in this questionnaire:

(E) Exceptional - The Contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.

(V) Very Good - The Contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.

(S) Satisfactory - The Contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Contractor appear or were resolved satisfactorily.

(M) Marginal - Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the Contractor has not yet identified corrective actions or the Contractor’s proposed actions appear only marginally effective or were not fully implemented.

(U) Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

(NA) Not Applicable – Unable to assess the area.

(CPARS “Quality of Service” Rating Area)

Provided qualified personnel IAW the Terms and Conditions of the contract.

Ensured that positions requiring qualified personnel remained filled IAW the Terms and Conditions of the contract.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:

(CPARS “Schedule” Rating Area)

Provided the actuarial and financial analyses to accomplish the pricing, re-pricing, adjustments, risk corridor, and equity loss determinations required by all health care and health care related contracts IAW the Terms of the contract.

Provided the analysis necessary to validate and certify the adjustment calculations IAW the Terms of the contract.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:

(CPARS “Management” Rating area)

Compared and contrasted the cost, effectiveness and scope of military health benefits programs, both TRICARE and the direct care program, with health benefit packages and programs offered in the civilian sector and in other government programs IAW the Terms of the contract.

Performed comparative analysis of utilization trends within the MHS, the private sector and other government programs, and how these trends have affected escalating health care costs IAW the Terms of the contract.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:

(CPARS “Management” Rating area)

Performed independent analyses of the offerors who are awarded future health care and health care related contracts IAW the Terms of the contract.

Analyzed an inventory of current TRICARE eligible, users, workload, and costs by category of service, estimated to completion of contract IAW the Terms of the contract.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements:

Would you award this firm another contract:

If you answered “No” provide an explanation:

Was the contract terminated for default or cause:

If you answered “Yes” provide an explanation:

Additional Comments:

Signature: _________________________________________ Date: __________________

Print Name:

Title:

Telephone:

Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.