W81K04-24-R-0021 Appendix D Performance Assessment Questionnaire.pdf

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W81K04-24-R-0021

Performance Assessment Questionnaire – Cover Letter

DEPARTMENT OF THE ARMY

US ARMY HEALTH CONTRACTING ACTIVITY

HEALTH READINESS CONTRACTING OFFICE

2199 STORAGE STREET, SUITE 68

JBSA FORT SAM HOUSTON, TEXAS 78234-5074

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) W81K04-24-R-0021

Dear Sir/Ma’am, The US Army Health Readiness Contracting Office (HRCO) is currently conducting a competitive source selection to evaluate offerors on the subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state, or local government or commercial contracts as compared to the North American Industry Classification System [NAICS] 339112. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to the HRCO, no later than 29 May 2024.

Submit your completed questionnaire to Mr. Harris Brown @ harris.s.brown.civ@health.mil and Mr. David Libby @ david.j.libby.civ@health.mil.

Your cooperation is greatly appreciated. Questions may be directed to the undersigned at david.j.libby.civ@health.mil or 210-221-4808, and harris.s.brown.civ@health.mil.

Sincerely, DAVID J. LIBBY

Contracting Officer

LIBBY.DAVID.

J.1163882317

Digitally signed by

LIBBY.DAVID.J.116388

Date: 2024.05.14 16:41:33 -05'00'

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W81K04-24-R-0021

Performance Assessment Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does (and/or) notify the Contracting Officer. Please return the completed Questionnaire to the Contracting Officer identified in the cover letter within the stated timeframe.

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements.

Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

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W81K04-24-R-0021

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: rationale is required for each response.

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: _________________________________________________________

B. Effectiveness of Project Management (to include use and control of subcontractors).

Rationale: __________________________________________________________

C. Timeliness of Performance for Services and Product Deliverables.

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D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

F. General Comments. Provide any other relevant performance information.

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Comments: _________________________________________________________

G. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name): __________________________________________ Telephone Number: ______________________________________________

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter: Mr. Harris Brown @ harris.s.brown.civ@health.mil and Mr. David Libby @ david.j.libby.civ@health.mil.

Thank you for your assistance.

mailto:harris.s.brown.civ@health.mil mailto:david.j.libby.civ@health.mil