REV Past Performance Questionnaire (HT001426QE033).docx

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 August 21, 2026, by 03:00 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:

Total Number of Full Time Employees employed:

Title of Position(s) provided by the Offeror

C. CONTRACTING OFFICER REPRESENTATIVE INFORMATION:

COR’s Name:

Telephone Number:

Email:

D. RATING INFORMATION:

E. PERFORMANCE EVALUATION QUESTIONS:

Quality of Services

Performance Rating

(1) The Contractor provided quality services that adhered to contract requirements, specifications, and standards of professional conduct.

(2) The Contractor provided quality personnel that met or exceeded the required qualifications.

(3) The Contractor demonstrated an overall effective and quality management effort.

(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 fill-rates established by the contract.

(2) The labor turnover in personnel and other labor categories (to include contracted interpreters and translators) was minimal and did not adversely affect Contractor Performance.

(3) The Contractor consistently demonstrated an ability to quickly recruit Interpreters on time to meet the Government’s needs.

(4) The Contractor demonstrated the ability to retain contractors to support contract/task order requirements so that work schedules would not be disrupted.

(5) The Contractor demonstrated the ability to plan for and provide replacement candidates to include pre-planned absences, unplanned illnesses, or an extended leave of absence.

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:

Exceptional ______ Very Good ______ Satisfactory ______ Marginal ______ Unsatisfactory ______

COMMENTS: (ALL Unsatisfactory, Marginal, Very Good, or Exceptional 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.