Past_Performance_Questionnaire.pdf

ATTACHMENT 4: PAST PERFORMANCE QUESTIONNAIRE

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

This requirement is to provide compression garments for Pressure Garment Therapy (PGT) for burn patients being treated at

Institute of Surgical Research (ISR), Brooke Army Medical Center (BAMC), Joint Base San Antonio - Fort Sam Houston, Texas.

Please complete the following questionnaire to assist our evaluation of the contractor's past performance, and return via email no later than 28 August 2019 to patricia.c.pfeninger.civ@mail.mil

Name of Contractor being evaluated:

1. How long has your company had a contract (or has been doing business) with this contractor?

2. What services/supplies are being provided?

3. Where is the location where this contractor provide services/supplies at?

4. What is the contract amount?

5. What items does this contractor supply?

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

If yes, please explain:

7. Given the opportunity, would you work with this company again?

The last three questions will discuss schedule performance, quality of service & customer relations.

Please refer to the following Rating System:

(1) Exceptional - Performance meets contractual requirements and exceeds many to the contractor's benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken were highlyeffective.

(2) Very Good - Performance meets contractual requirements and exceeds some to the Contractor's benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken were effective.

(3) Satisfactory - Performance meets the contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken appear or were satisfactory.

(4) Marginal - Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The proposed actions appear only marginally effective or were not fully implemented.

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

mailto:patricia.c.pfeninger.civ@mail.mil

1. Schedule Performance - Please rate overall compliance with reliability and timeliness of scheduled performance.

(1) Exceptional (2) Very Good (3) Satisfactory (4) Marginal (5) Unsatisfactory

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

2. Quality of Service - Please rate overall compliance with contract statement of work requirement.

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

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

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

Signature: Date:

Print Name: Company:

Title: Telephone:

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