Past Performance Questionnaire.doc
DOC document 58 KB Posted
- Attached to
- Medical and Dental Readiness Services
- Solicitation number
- W912L6-22-R-0003
- Issued by
-
Department of the Army National Guard
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Other files
| File | Type | Posted |
|---|---|---|
| Summary of Changes_28Mar22.pdf | ||
| RFI Log_24Mar22.pdf | ||
| W912L6-22-R-0003 Amendment 0002.pdf | ||
| Past Performance Questionnaire.doc | DOC document | |
| W912L6-22-R-0003 Amendment 0001.pdf | ||
| W912L6-22-R-0003.pdf | ||
| W912L6-22-R-0003 Amendment 0001 Summary of Changes.pdf | ||
| W912L6-22-R-0003.pdf |
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Date: 7APR22
Solicitation # W912L6-22-R-0003
PERFORMANCE QUESTIONNAIRE
Your assistance is requested in support of a source selection.
Please complete this Questionnaire and send by email to: joseph.b.jarvis.civ@army.mil along with proposal.
When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.
VENDOR
| 1. CONTRACTOR NAME & ADDRESS: |
| 2. CONTRACT NO.: |
3. CONTRACT INITIATION DATE:
4. COMPLETION DATE:
5. CONTRACT VALUE (with options):
6. TYPE OF CONTRACT:
7. DESCRIPTION OF CONTRACT REQUIREMENTS:
A requirement for a routine, annual Periodic Health Assessment (PHA) and Dental Examination to be conducted for all members of the Active Duty and the Selected Reserves. This program focuses on optimizing the health and wellness of Soldiers. Reference PWS for details
Please add a continuation page if additional space necessary.
TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE
8. EVALUATION: a. EVALUATOR'S NAME, POSITION (PCO/COTR/OTHER) AND ORGANIZATION:
b. EVALUATOR'S PHONE NUMBER: c. DURATION OF BUSINESS RELATIONS WITH NAMED FIRM:
Please Circle the response code which best reflects your experience with this contractor.
EX = Exceptional - Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
VG = Very Good - Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
S = Satisfactory - Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
MG = Marginal - Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or where not fully implemented.
US = Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’ corrective actions appear or were ineffective.
N/O = Not Observed
[Please Provide Comments to Identify Specific Strengths/Weaknesses in each area) see page 2.
A. Offerors Business Practices -
Business/Contracting Relations
EX
VG
S
MG
US
N/O
Problem Resolution
EX
VG
S
MG
US
N/O
Process Improvement
EX
VG
S
MG
US
N/O
Lesson Learned Incorporation
EX
VG
S
MG
B. Customer Relationship-
Cooperative Behavior
EX
VG
S
MG
US
N/O
Commitment to Customer Satisfaction
EX
VG
S
MG
US
N/O
Responsiveness
EX VG
S
MG
US
N/O
C. Ability to Successfully Perform-
Training
EX
VG
S
MG
US
N/O
Design, Development and Performance of Course
Instruction EX
VG
S
MG
US
N/O
Course Curriculum
EX
VG
S
MG
US
N/O
Course benefit in work place EX
VG
S
MG
US
N/O
B. Prior Experience -
Personnel Technical Knowledge in subject EX
VG
S
MG
US
N/O
D. Adherence to Schedule -
Vendor adherence to scheduled dates
EX
VG
S
MG
US
N/O
E. Quality of Contractors Team-
Thoroughness EX
VG
S
MG
US
N/O
Accuracy EX
VG
S
MG
Overall Quality
EX
VG
S
MG
US
9. Overall Assessment: (a) EXCEPTIONAL (b) VERY GOOD (c) SATISFACTORY (d) MARGINAL (e) UNSATISFACTORY (f) NOT OBSERVED
10. Any unsatisfactory performance identified above has been shared with the contractor. ( ) Yes: written or oral ? ( ) No
PLEASE PROVIDE COMMENTS TO IDENTIFY:
a. Specific Strengths/Weaknesses Related to Part 8 Above -- Please Cite the Alpha-Numeric Criteria Code.
b. Two or Three Best Corporate "Traits" or Skills Observed.
c. Any Areas of Performance that are the Most "Troublesome".
Please add a continuation page for comments
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