Exhibit L-4 - Past Performance Questionnaire

Exhibit 4 - Past Performance Questionnaire
TRICARE Medicare Eligible Program (TMEP2)

PAST PERFORMANCE QUESTIONNAIRE

SOURCE SELECTION INFORMATION

Please complete this questionnaire and email it as a PDF attachment to [email protected] and [email protected]. The Government cannot access PPQs submitted using HTML links due to information security restrictions.
Responses will be treated as confidential and will be used only by source selection officials in evaluating the offeror’s submitted documents for the contract pursuant to FAR 2.101 and 3.104.
Name of Offeror/Team
Submitting Proposal
in Response to
HT940226R0001
Name of Contractor/
Subcontractor which
Performed the Work
Described in this PPQ:
Role: (Prime?
Subcontractor?)

DUNS #

CAGE Code:
Relation to Offeror:
Client’s Name:
Contract # if applicable:

e.g. X company is/was the Prime or Y company is/was a subcontractor to Z company

Task Order # if
applicable:
Contract Type (See FAR
16): For example: Fixed price

Advisory & Assistance Services,
MATOC IDIQ for base year and 3
option years; or CPFF Services
for base year and 2 option years.

Total Contract Value at
Award:
Total Contract Value
Exercised to Date*:
Contract Period of
Performance

Start Date:
End Date:

TCRS HT940226R0001, Exhibit 4

Exhibit 4 - Past Performance Questionnaire
NAICS Code:
Product Service Code:
Client’s Address:

Client’s Primary Point of
Contact Name
Title:
Phone:
Email Address:
Client’s Alternate Point of
Contact Name
Title:
Phone:
Email Address:
Description of Magnitude Describe magnitude of services in relation to RFP criteria at of Services of the
M.7.3.2.
Referenced Contract

TCRS HT940226R0001, Exhibit 4

Exhibit 4 - Past Performance Questionnaire
Description of Tasks
Performed

Description not to exceed space given.

*Total dollar value exercised to date if offeror was the prime contractor. If the offeror performed as a first-tier subcontractor on the contract, state the total contract dollar value and identify the dollar value awarded to the subcontractor.
TCRS HT940226R0001, Exhibit 4

Exhibit 4 - Past Performance Questionnaire
Client Portion of PPQ
INSTRUCTIONS: Please provide your responses to the questions below. Questions 1-3 pertain to the contractor’s performance in relation to the stated terms of the contract (contract requirements, timeliness/processing standards, etc.). Questions 4–7 pertain to the manner in