REV2 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 25, 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:

C. CONTRACTING OFFICER REPRESENTATIVE INFORMATION:

COR’s Name:

Telephone Number:

Email:

D. RATING INFORMATION:

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.