Past_Performance_Attachment.docx

PAST PERFORMANCE QUESTIONNAIRE

The Regional Health Contracting Office - Central is conducting a competitive acquisition. The offeror has identified you as a reference to validate past performance.

Please complete the following questionnaire to assist our evaluation of the contractor’s past performance, and return preferably via email no later than 30 June 2016, 10:00 AM CST.

POC: Mr. Anthony Browner, RHCO-C, MEDCOM, Fort Hood, TX. EMAIL: anthony.d.browner.civ@mail.mil or FAX: 254-553-3906.

Name of Contractor being evaluated:

1. How long has your company had a contract with this contractor?

2. Type of service being provided? _______________________________________________________

3. Where is the location of this service?____________________________ _________________

4. What is the contract amount?___

5. How many Full Time Equivalents (FTE) are on the contract?

6. Have there been late deliveries or other unsatisfactory performance resulting in additional contractual or administrative?

If “Yes,” explain:

The last two questions will discuss quality of service & customer relations. Please refer to the following:

Rating System:

(1) Superior – Overall performance exceeds contractual requirements and gives extra benefits to the customer. Problems, if any, were promptly corrected without negative impact to the customer.

(2) Satisfactory – Performance meets contractual requirements. The contractual performance contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(3) Marginal - Performance does not meet some contractual requirements. The contractor’s proposed actions to correct any problems appear only marginally effective or were not fully implemented.

(4) Unsatisfactory – Performance does not meet most contractual requirements. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

IMPORTANT NOTE: NARRATIVES MUST BE PROVIDED FOR ANY RATING OTHER THAN SATISFACTORY AND MUST SUPPORT THE RATING GIVEN.

PAST PERFORMANCE QUESTIONNAIRE, Continued

7. Quality of Service – Please rate overall compliance with contract statement of work requirement.

(1) Superior (2) Satisfactory (3) Marginal (4) Unsatisfactory

If other than “Satisfactory,” a narrative must be provided to explain how the overall performance exceeds or does not meet contractual requirements performance exceeds or does not meet contractual requirements:

8. Business/Customer Relations – Please rate overall effective management; successfully managed services; reasonable/cooperative behavior; flexibility; business-like concern for customer’s interest.

(1) Superior (2) Satisfactory (3) Marginal (4) Unsatisfactory

If other than “Satisfactory,” a narrative must be provided to explain how the overall performance exceeds or does not meet contractual requirements:

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

Past and Present PERFORMANCE RISK (Past Performance) ratings assess the risks associated with each quoter's likelihood of success in performing the requirements stated in the RFQ based on that quoter's demonstrated performance on recent, relevant contracts. The risk assessment will be based on two components, i.e., ratings for past work and relevancy of past work to this project. Less relevant work will receive less weight. It is the quoter's responsibility to establish relevancy of past work to this project.

Excellent

Good Adequate Marginal Poor Unknown Essentially no doubt exists that the quoter will successfully perform the required effort based on their

Performance record. Risk level: Very low Little doubt exists that the quoter will successfully perform the required effort based on their

Performance record. Risk level: Low Some doubt exists that the quoter will successfully perform the required effort based on their

Performance record. Risk level: Moderate Significant doubt exists that the quoter will successfully perform the required effort based on their

Performance record. Risk level: High It is extremely doubtful that the quoter will successfully perform the required effort based on their

Performance record. Risk level: Very High The quoter has little/no relevant past performance upon which to base a meaningful performance risk prediction. Risk level: Neutral

Sources: AFARS – Appendix AA – Army Source Selection Manual dated 26 Feb 09 image20.png image3.png image30.png image1.png image10.png image2.png