past performance questionnaire

Section J – List of Documents, Exhibits, and Other Attachments

Attachment J-1: U.S. Military Entrance Processing Station Locations

Eastern Sector Western Sector1 Albany NY 1 Albuquerque NM 2 Atlanta GA 2 Amarillo TX 3 Baltimore MD 3 Anchorage AK 4 Beckley WV 4 Boise ID 5 Boston MA 5 Butte MT 6 Buffalo NY 6 Dallas TX 7 Charlotte NC 7 Denver CO 8 Chicago IL 8 Des Moines IA 9 Cleveland OH 9 El Paso TX

10 Columbus OH 10 Fargo ND 11 Detroit MI 11 Honolulu HI 12 Fort Dix NJ 12 Houston TX 13 Fort Jackson SC 13 Kansas City MO 14 Fort Lee VA 14 Little Rock AR 15 Harrisburg PA 15 Los Angeles CA 16 Indianapolis IN 16 Minneapolis MN 17 Jackson MS 17 New Orleans LA 18 Jacksonville FL 18 Oklahoma City OK 19 Knoxville TN 19 Omaha NE 20 Lansing MI 20 Phoenix AR 21 Louisville KY 21 Portland OR 22 Memphis TN 22 Sacramento CA 23 Miami FL 23 Salt Lake UT 24 Milwaukee WI 24 San Antonio TX 25 Montgomery AL 25 San Diego CA 26 Nashville TN 26 San Jose CA 27 New York NY 27 Seattle WA 28 Pittsburgh PA 28 Shreveport LA 29 Portland ME 29 Sioux Falls SD 30 Raleigh NC 30 Spokane WA 31 San Juan PR 31 St Louis MO 32 Springfield MA33 Syracuse NY34 Tampa FL

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Map of Cities with U.S. Military Entrance Processing Station

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Attachment J-2: U.S. Military Entrance Processing Station Workload Estimates

Non-Prior Service Enlistments

Period NUMBER of Enlistments

2006 60,1772007 60,6352008* 41,231Note: As of 05 Jun 2008

Non-Prior Service Enlistments by Month and Year (2006 to present)

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Number of Applicants by MEPS Facility for 2007

Facility ARNG USA USAR ANG TotalAlbany, New York 1,289 1,414 423 460 3,586Albuquerque, New Mexico 579 736 188 73 1,576Amarillo, Texas 863 1,294 213 0 2,370Anchorage, Alaska 568 482 114 170 1,334Atlanta, Georgia 2,865 4,430 1,654 174 9,123Baltimore, Maryland 1,765 3,650 1,245 271 6,931Beckley, West Virginia 1,103 1,046 427 52 2,628Boise, Idaho 778 749 156 204 1,887Boston, Massachusetts 2,659 2,200 780 318 5,957Buffalo, New York 679 1,357 431 68 2,535Butte, Montana 683 600 179 71 1,533Charlotte, North Carolina 2,160 2,327 744 108 5,339Chicago, Illinois 2,447 3,755 1,272 99 7,573Cleveland, Ohio 1,818 2,077 649 58 4,602Columbus, Ohio 1,780 3,140 1,183 533 6,636Dallas, Texas 1,868 5,457 1,400 39 8,764Denver, Colorado 1,205 2,693 729 220 4,847Des Moines, Iowa 2,150 1,062 618 85 3,915Detroit, Michigan 1,265 1,841 492 223 3,821El Paso, Texas 766 1,176 324 27 2,293Fargo, North Dakota 1,030 298 111 86 1,525Fort Jackson, South Carolina 3,434 2,993 1,082 122 7,631Harrisburg, Pennsylvania 2,881 2,080 1,014 143 6,118Honolulu, Hawaii 1,240 1,006 539 372 3,157Houston, Texas 1,262 5,274 1,121 77 7,734Indianapolis, Indiana 4,000 2,045 671 133 6,849Jackson, Mississippi 2,018 885 447 329 3,679Jacksonville, Florida 2,097 4,523 1,285 219 8,124Kansas City, Missouri 2,849 2,994 1,259 272 7,374Knoxville, Tennessee 2,070 1,409 543 184 4,206Lansing, Michigan 1,940 2,582 623 121 5,266Little Rock, Arkansas 2,537 1,563 619 138 4,857Los Angeles, California 2,418 4,881 1,036 149 8,484Louisville, Kentucky 1,513 1,422 565 88 3,588Memphis, Tennessee 2,808 1,186 478 95 4,567Miami, Florida 844 2,730 790 2 4,366Milwaukee, Wisconsin 2,189 2,061 986 127 5,363Minneapolis, Minnesota 3,412 1,134 551 209 5,306Montgomery, Alabama 3,492 3,505 1,201 248 8,446Nashville, Tennessee 2,918 2,109 612 81 5,720New Orleans, Louisiana 2,366 1,630 437 230 4,663New York, New York 2,595 4,050 1,484 170 8,299Oakland, California 1,117 2,723 675 164 4,679Oklahoma City, Oklahoma 2,317 2,557 835 228 5,937Omaha, Nebraska 741 784 394 89 2,008

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Facility ARNG USA USAR ANG TotalPhiladelphia, Pennsylvania 3,004 3,359 1,168 551 8,082Phoenix, Arizona 1,858 3,645 740 186 6,429Pittsburgh, Pennsylvania 1,115 1,943 1,255 136 4,449Portland, Maine 765 857 168 110 1,900Portland, Oregon 2,159 1,641 382 223 4,405Raleigh, North Carolina 2,011 3,571 848 17 6,447Richmond, Virginia 2,406 3,675 945 101 7,127Sacramento, California 2,116 3,818 564 128 6,626Salt Lake City, Utah 1,994 2,090 653 117 4,854San Antonio, Texas 1,698 4,905 1,492 50 8,145San Diego, California 1,007 2,242 445 95 3,789San Juan, Puerto Rico 3,199 1,625 1,546 308 6,678Seattle, Washington 883 1,920 577 70 3,450Shreveport, Louisiana 1,548 1,530 383 33 3,494Sioux Falls, South Dakota 858 502 180 190 1,730Spokane, Washington 727 773 159 58 1,717Springfield, Massachusetts 2,033 1,677 458 189 4,357St Louis, Missouri 2,960 3,408 1,223 268 7,859Syracuse, New York 778 1,349 468 137 2,732Tampa, Florida 1,353 5,073 1,098 30 7,554National 119,850 149,513 47,331 10,326 327,020

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Attachment J-3: Applicable Publications, Regulations, and Forms

USMEPCOM DOCUMENTS

USMEPCOM Documents Available Online

The following MEPCOM documents are available at the following website

http://www.mepcom.army.mil/publications/pubnform.asp?topic=Regulations&sort=pdfFile

USMEPCOM Regulation 40-1: Medical Processing and Examinations

This regulation is to establish policies and procedural guidance for conducting military entrance processing station (MEPS) medical examinations. Chapters 4-7 deal with some specifics on the physical evaluation of examinees.

USMEPCOM Regulation 601-23: Enlistment Processing

This regulation provides policies and procedures on applicant processing; matters relating to preparing, maintaining, and distributing enlistment documents (including interviewing and fingerprinting enlistment applicants); and processing Entrance National Agency Check/National Agency Check (ENTNAC/NAC) requests. It also provides instructions for implementation of Military Entrance Processing Station (MEPS) functions required by service directives. Chapter 4 Medical Examination and Enlistment Files.

Supplemental Medical Processing Guidance (SMPG) Chart Version: 20060618-2100 [For MEPS Examinees in 40-Plus Category]

This guidance provides the details on what testing is required for the “over 40 age” group. In reality, this testing is done for all applicants age 39 and over. If the applicant ships before age 40, then this lab is not needed, but given the delays that sometimes occur in shipping, we will do the “over 40” testing for all applicants 39 and older.

This document is available online at the following website

http://www.dmna.state.ny.us/arng/ocs/forms/Supplemental_Medical_Processing_Guidance_Chart.doc.

USMEPCOM Regulation 40-8: Human Immunodeficiency Virus (HIV) and Department Of Defense (DOD) Precessions Drug and Alcohol Testing (DAT) Program

This regulation prescribes policies and procedures for conducting HIV and DAT in the Military Entrance Processing Stations (MEPS). Changes have been made throughout the regulation. All United States Military Entrance Processing Command (USMEPCOM) forms previously used in the superseded regulations have been revised. This regulation establishes a new form, USMEPCOM Form

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40-8-5-R (Urine Sample Custody Document Statement of Correction). All references to the Standard Form 88 (Report of Medical Examination) and Standard Form 93 (Report of Medical History) refer to the USMEPCOM overprinted versions.

USMEPCOM Regulation 40-8 Updates

USMEPCOM Regulation 40-8i1 Human Immunodeficiency Virus (HIV) and Department of Defense (DOD) Precessions Drug and Alcohol Testing (DAT) Program, IMC 1

USMEPCOM Regulation 40-8-i2 Human Immunodeficiency Virus (HIV) and Department of Defense (DOD) Precessions Drug and Alcohol Testing (DAT) Program, IMC 2



USMEPCOM Regulation40-8-i7 Human Immunodeficiency Virus (HIV) and Department of Defense (DOD) Precessions Drug and Alcohol Testing (DAT) Program, IMC 7








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USMEPCOM Documents Not Available Online

These documents are not available online.

MEPS HIV Forms and Examples

mmd_tng_00++HIV Forms and Examples, HIV_DAT Included within this document are a set of additional documents that define and provide guidance on the handling of HIV tests including indeterminate and positive HIV tests.

Routine Supplemental Medical Processing: 40-Plus Checklist

This document, titled Routine Supplemental Medical Processing: 40-Plus Checklist, is part of the Chronological Record of Medical Care. USMEPCOM uses the 40 plus checklist to document completion of required lab tests and scoring of the lab tests. This file, named 40-PLUS includes a checklist of required labs for “over 40” lab for males and females. It also includes a scoring system for the cardiovascular risk history.

OrthoNeuro exam

Detailed description of the “OrthoNeuro” group exam which is the screening exam done by one HCP with multiple examinees simultaneously.

DEPARTMENT OF THE ARMY DOCUMENTS

Army Documents Available Online

Army Regulation 40-501, STANDARDS OF MEDICAL FITNESS

This regulation contains standards for Chapter 2, Chapter 3, and Special Forces Physicals. Chapter 5: Medical Fitness Standards for Special Forces training,


http://www.usapa.army.mil/pdffiles/r40_501.pdf

Army Height and Weight Chart

Height and Weight chart for Initial applicants (Non Prior Service) and Commissioning Physicals, AMEDD, Prior Service or Current Members of USA list the heights and weights for non-prior service and prior service including AMEDD.

The Army Weight table is available online at the following website

http://www.usarec.army.mil/hq/apa/rc/weight.htm

AR 40-501 Section 8–26. Cardiovascular Screening Program (CVSP)

The Cardiovascular Screening Program (CVSP) is required as part of the periodic health assessment for all the Active Army, ARNG/ARNGUS, and USAR

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(Selective Reserve) Soldiers age 40 and older. Cardiovascular screening will be done every five years unless otherwise clinically indicated.


http://www.usapa.army.mil/pdffiles/r40_501.pdf

DEPARTMENT OF DEFENSE

Official Department of Defense Issuances Website

The following is the official website for Department of Defense issuances.

http://www.dtic.mil/whs/directives/corres/ins1.html

DoD Documents Available Online

DD Form 2807-1: Report of Medical History

This is a medical prescreening form. Its purpose is to obtain medical data for determination of medical fitness for enlistment, induction, appointment and retention for applicants and members of the Armed Forces. The information will also be used for medical boards and separation of Service members from the Armed Forces.

These are the paper forms used to record the results of the prescreen, history and exam along with lab work. They are provided for information only.

It is available online at the following website

http://www.mepcom.army.mil/publications/pubnform.asp?topic=Forms&sort=pdfFile

DD Form 2807-2: Medical Prescreen Of Medical History Report

This form is to be completed by each individual who requires medical processing in accordance with Army Regulation 40-501 Chapter 2 standards, or Department of Defense Directive 6130.3, "Physical Standards for Appointment, enlistment, or Induction”. The applicant should complete the form with the assistance of the recruiter, parent(s), or guardian, as needed.


This form is available online at the following website:

http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2807-2.pdf

DD Form 2808: Report of Medical Examination

The purpose of this form is to obtain medical data for determination of medical fitness for enlistment, induction, appointment, and retention for applicants and members of the Armed Forces. The information will also be used for medical boards and separation of Service members from the Armed Forces.

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This form is available online at the following website:

http://www.mepcom.army.mil/publications/pubnform.asp?topic=Forms&sort=pdfFile

Department of Defense Regulation 6130.4: “Criteria and procedure requirements for physical standards for Appointment, enlistment or Induction in the Armed forces

This regulation is available online at the following website:

http://www.dtic.mil/whs/directives/corres/pdf/613004p.pdf.

OSD 04684-06 (2).pdf and HIV_DAT.txt Drug and Alcohol Test:

SECDEF Policy governs content and use of DOD certified lab. OSD 04684-06 (2), Implementation of Department Drug Demand Reduction Policy 1203,

Document that clarifies significance of medical conditions.

DOD Instruction 6130.4, "Medical Standards for Appointment, Enlistment, or Induction in the Armed Forces", January 18, 2005

This Instruction reissues DOD Directive 6130.4, "Medical Standards for Appointment, Enlistment, or Induction in the Armed Forces”, April 2, 2004 to implement policy and assign responsibilities for Medical Standards for Appointment, Enlistment, or Induction in the Armed Forces activities under DoD Directive 6130.3,"Physical Standards for Appointment, Enlistment, or Induction," December 15, 2000.

OTHER PUBLICATIONS

Federal Information Security Management Act of 2002 ("FISMA", 44 U.S.C. § 3541, et seq.)

FISMA is a United States federal law enacted in 2002 as Title III of the E-Government Act of 2002 (Pub.L. 107-347, 116 Stat. 2899). The Act was meant to bolster computer and network security within the Federal Government and affiliated parties (such as government contractors) by mandating yearly audits.

Health Insurance Portability and Accountability Act (HIPAA)

This act was enacted by the US Congress in 1966 Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS)

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provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

Electronic web-based Reports of consultation will be appended to DD Form 2808 or PHA Department of Defense Regulation 6130.4. Final form TBD.

Compliance Documents

The following documents provide specifications, standards, or guidelines that must be complied with in order to meet the requirements of this contract:

• DoD Technical Reference Model, Version 1.0, November 5, 1999

• Defense Data Dictionary System (DDDS), latest version (http://www-datadmn.itsi.disa.mil/ddds/ddds40.html )

• Industry Implementation of International Standard ISO/IEC 12207: 1995

• DODD 8320.1, “DoD Data Administration,” March 1994 (http://www.dtic.mil/whs/directives/corres/pdf/d83201_092691/d83201p.pdf)

• Principle Deputy Assistant Secretary for Health Affairs (PDASD-HA Memo, “Use of DoD Standards in MHS Migration Systems,” 11 March 1996) (http://www.tricare.osd.mil/policy/fy96/mhss36.html )

• CJCSI 6212.01A-C4I Certification of Networthiness. For Interoperability Certification (C4I), also see DoD 4630.5, DoDI 4630.8, 15 February 2000.

• Information Technology Management Reform Act of 1996 (also known as Clinger-Cohen Act of 1996)

• Interim Defense Acquisition Guidebook, October 2002. http://dod5000.dau.mil/

• DoD Regulation 5200.2-R, DoD Personnel Security Program, April 9, 1999 (http://www.dtic.mil/whs/directives/corres/pdf/d52002_040999/d52002p.pdf)

• DoD 5200.28-STD, Trusted Computer System Evaluation Criteria (http://www.radium.ncsc.mil/tpep/library/rainbow/5200.28-STD.html )

• Deputy Assistant Secretary of Defense for Health Budgets and Programs (PDASD-HBP Memo) FY97 Defense Health Program (DHP) Funding Guidance - Revised, 2 December 1996.

• PL 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 (http://aspe.hhs.gov/admnsimp/pl104191.htm)

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• DoD 5136.1-P, DoD Medical Readiness Strategic Plan, 1998-2004.

• Defense Medical Human Resource System (DMHRS) Evaluation and Advisory

• DMHRS II System Requirements Specification (draft)

• OMB Circular A-130, “Management of Federal Information Resources", 11/28/2000.

• AR 40-3, Medical, dental and Veterinary care

• AR 600-110, Identification, Surveillance, and Administration of Personnel Infected with Human Immunodeficiency Virus (HIV)

• AR 40-66, Medical Record Administration and Health Care Documentation

• AR 40-501, Standards of Medical Fitness

• AR 40-562, Immunizations and Chemoprophylaxis

• DA Pam 40-501, Hearing Conservation Program

• DA Pam 40-506, The Army Vision Conservation and Readiness Program

• MILPERSMAN ARTICLE 6110-020, Physical Risk Classification for Officer and Enlisted Personnel on Inactive Duty, 29 Dec 06

Reference Documents

The following documents may be helpful to the Contractor in performing the work described in this contract:

• Glossary of Defense Acquisition Acronyms and Terms (2001) Website (http://www.dau.mil/pubs/glossary/preface.asp)

• Software Assurance Guidebook, NASA-GB-A201• The Government Contracts Reference Book, Schooner, Steven L., second

edition, 1998• Defense Technical Information Center Website (www.dtic.mil)• Defense Contract Audit Agency (DCAA) Website

(www.dcaa.mil/main.html).• MHS Automated Information System (AIS) Security Policy Manual,

Version 1.0, April 1996, modified on February 2000 (http://www.tricare.osd.mil/imtr/mhssaisa.html)

• MHS Information Management (IM) / Information Technology (IT) Strategic Plan, 1999 - 2003 (http://www.tricare.osd.mil/infomgt/imitstra.pdf)

• MHS IM/IT Program Plan, Volume I and II, February 1999 (http://www.tricare.osd.mil/imtr/poliregu.html)

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• Principle Deputy Assistant Secretary for Health Affairs (PDASD-HA Memo, Use of DoD Standards in MHS Migration Systems, 11 March 1996) (on TRICARE web site)

• DODI 5200.40 DoD Information Technology Security Certification and Accreditation Process (DITSCAP), December 30, 1997

Attachment J-4: Acronyms and Definitions

Title Description

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Accession Physical Evaluation

Initial Physical examination, specialty consults and lab testing IAW with AR 40-501 and DODI 6130.4. Drug and Alcohol Test: IAW SECDEF Policy

ANG Air National GuardARNG Army National Guard since 1636. The oldest component of the Armed

Forces of the United States is a reserve component of the United States Department of the Army

ASM Army Strength MaintenanceChief Medical Officer Physician responsible for medically qualifying or disqualifying the

applicant

Childress test Childress test is done during the duck walk to assess for meniscus tear.

COR Contracting Officer Representative. An authorized representative of the Contracting Officer acting within the limits of his/her authority in administering a contract as delegated in writing by the Contracting Officer

COTR Contracting Officer’s Technical Representative. An individual from the Government , normally a Non-commissioned Officer-In-Charge (NCOIC) who will provide technical expertise to the COR as required

CVRHx Cardiovascular Risk HistoryDiagnostic Imaging Includes but is not limited to Nuclear Medicine

Magnetic Resonance Imaging (MRI) Computerized Tomography (CT) Catheterization Lab Ultrasound and Echocardiography Mammography and Stereotactic Breast Biopsies PET/CT Vascular studies X-Ray

DAT Drug and Alcohol TestingDOD Department of DefenseDuck walk A test used by MEPS to screen for abnormalities in neuromuscular

function, balance in the lower extremities. The Childress test “AKA duck walk” is a screening tool to evaluate Orthopedic and Neurological conditions. The duck walk is used as an assessment of lower extremities mobility and strength and tests your overall balance while in a crouch position.

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E-Authentication Guidance for Federal Agencies, OMB M-04-04

The OMB guidance defines the required level of authentication assurance in terms of the likely consequences of an authentication error. As the consequences of an authentication error become more serious, the required level of assurance increases. The OMB guidance provides agencies with the criteria for determining the level of e-authentication assurance required for specific applications and transactions, based on the risks and their likelihood of occurrence of each application or transaction.

E-Government Act of 2002

Public Law 107-347. Its stated purpose is to improve the management and promotion of electronic government services and processes by establishing a Federal Chief Information Officer within the Office of Management and Budget, and by establishing a framework of measures that require using Internet-based information technology to improve citizen access to government information and services, and for other purposes

Facilities Building, equipment, and supplies necessary for the implementation of services by personnel

FISMA Federal Information Security Management ActFOUO For Official Use OnlyGFE Government Furnished EquipmentHCP Healthcare Provider -- A licensed Doctor (MD) or (DO), physician

assistant (PA), nurse practitioner (NP), Optometrist, Audiologist who conducts accession medical screening examinations. This includes HCP who provide Specialty Consultations/Consults

HCPNet Health Care Provider (HCP) services networkHIPAA Health Insurance Portability and Accountability Act of 1996HIV Human Immunodeficiency VirusIAW In Accordance WithICD-9 International Classification of Diseases 9 (ICD-9)IDIQ Indefinite Delivery Indefinite QuantityInitial Physical Evaluation

Includes the acquisition and review of all prescreen, medical history, performance of physical examination, obtaining of all required age and gender appropriate lab work IAW DOD requirements, AR 40-501. DoDi 6130.4, USMEPCOM 40-1, 40-8, Cardiovascular risk History and all over age 40 lab work

IT Information TechnologyKO Contracting Officer. A person with the written authority to enter into,

administer, and/or terminate contracts and make related determinations and findings

LOE Level of EffortMEPS Military Entrance Processing Station

MEPS CVRHx MEPS Cardiovascular Risk History. Part of Routine Supplemental Medical Processing

NCOIC Non-Commissioned Officer-In-Charge

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NG National GuardNGB-ASM National Guard Bureau-Army Strength MaintenanceOMB Office of Management and BudgetOSD Office of the Secretary of DefensePRS Performance Requirement SummaryPWS Performance Work StatementRoutine Supplemental Medical Processing

Also known as 40 plus checklist .Set of specific gender specific lab work done for any applicant at age 39 or older. It includes MEPS CVRHx

RSID Recruiter Station IdentificationSECDEF Secretary of DefenseSpecialty Consultations/Consults

A HCP certified by The American Board of Medical Specialties (ABMS), such as Orthopedics, Ophthalmology, Dermatology, Neurosurgery, Neurology, Cardiology, Allergy, Pulmonary, Endocrinology, Nephrology, Gastroenterology, Oncology, Rheumatology, Podiatry, Gynecology, Otolaryngology, Urology, Psychiatry

Test(s) Test(s) will include all lab work, medical imaging, lab samples obtained during evaluations, electrocardiograms, etc.

TO Task OrderTORP Task Order Requirements PackageUSMEPCOM United State Military Entrance Processing Command54 States and US Territories

The 50 United States, The District of Columbia, the US Virgin Islands, Guam, Puerto Rico

Attachment J-5: Past Performance Questionnaire

Past Performance Questionnaire

The organization named below is asking you to be a past performance reference by completing this questionnaire. The Government refers to this organization as the offeror. You are the client.

1. Name of Offeror:

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This questionnaire is part of the offeror’s response in a Government source selection. By requesting you to complete this questionnaire, the offeror intends to use you as a reference for Government source selection evaluation purposes. The Government considers the information you provide here to be Source Selection Sensitive and confidential. The Government intends to use this data only for this source selection.

The Government asks that your answers to questions be honest and forthright and to the best of your knowledge. The Government will not share your responses outside of this source selection. To ensure fairness and impartiality, you are to mail your completed and signed questionnaire directly to the Government using the pre-addressed and prepaid envelopes. The offeror is required to provide you prepaid and pre-addressed envelope(s). Be aware that the offeror is not to participate in your questionnaire responses in any way whatsoever.

This questionnaire has three parts. The offeror has to complete Part I. In Part I, the offeror tells you the particular contract or project he wants to use as his reference. Part II is your responsibility. In Part II, the questionnaire asks you to provide performance information about the reference contract or project. Part III contains definitions to help you in your assessments. You’ll have to refer to these definitions to accurately complete the questionnaire.

If for any reason you are unable to complete this questionnaire, please complete item 10 and forward this questionnaire to the Government using the envelopes provided.

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1.1 Part I: Reference Background Information

The Offeror using you as a reference is required to complete Part I of this questionnaire.

Client and Reference Project/Contract Information: The Offeror shall provide the following information

2. Name of Client:_____________________________

3. Contract Title:____ ____________________________

4. Type of Contract: _______________________________

5. Contract Number: _________________________________

6. Contract Value: ___________________________________

7.Period of Performance:_______________________________

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1.2 Part II: Past Performance Questions

You are requested to complete Part II of this questionnaire, which involves filling out the Client Assessment of Past Performance table. There are three factors to address: Management and Client Relationships, Quality of Service, and Cost Control. You are to assess each factor and mark an X in the appropriate column in the table.

Please use the ratings scheme defined in Part III of this questionnaire. In addition, please study the performance category definitions, rating definitions and the rating scheme found in Part III of this questionnaire before assessing client performance.

Client Assessment of Past Performance

PERFORMANCE FACTOR

UNSATISFACTORY

MARGINAL GOOD VERY GOOD

EXCELLENT

Management and Client Relationships

Quality of Service

Cost Control

If your rating for any factor is excellent or unsatisfactory, please provide supporting data as requested below.

1. Excellent Performance: Please provide remarks regarding your excellent performance ratings. Please include data supporting this observation; you may continue on a separate sheet if needed. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Unsatisfactory Performance: Please provide remarks regarding your unsatisfactory performance ratings. Please include data supporting this observation; you may continue on a separate sheet if needed. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3 Affiliations: Please identify any corporate affiliation you have with the offeror___________________________________________________________

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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Other Comments: Please provide any other comments that you wish to make: you may continue on a separate sheet if needed_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Would you do business with ____________________________________again? (Insert offeror’s name)

The following requests contact information who completed the questionnaire. Please provide this information.

This questionnaire was completed by:

Client Name ___________________________________________________

Title:____________________________________________________________

Mailing Address (Street and P.O. Box):, City, State, and Zip Code:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Telephone Number: ___________________________________________

Fax Number:_________________________________________________

Date Information Provided: _____________________________________

Signature:______________________, Date:_____________________

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Note: This is the Government Contracting Officer’s mailing address.

Attn: Capt. Theresa Glasgow, Contracting Officer

Solicitation #: W9133L-08-R-2018

NGB-AQ; Suite 8100

1411 Jefferson Davis Hwy

Arlington, VA 22202-3229

This address should be the same address as shown on the pre-paid and pre-addressed envelopes that the offeror provided for you. To ensure your confidentiality in the event you misplace the pre-paid and pre-addressed envelopes the offeror provided, please mail the questionnaire to the Government Contracting Officer at the above address. Do not mail your questionnaire to the offeror, as doing so may prevent the Government from using your assessments in the source selection evaluation and could prevent the Government using information beneficial to the offeror.

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1.3 Part III: Performance Categories, Definitions, and Ratings

The Government requests that you base your assessment of the offeror considering the performance assessment descriptions for each of the three performance categories. Use the appropriate assessment shown in the tables below as your entry in the Client Assessment of Past Performance table in Part II of this questionnaire.

To ensure consistency, please formulate your performance assessments based upon the assessment definitions table for each performance factor, which are found in the tables below. Select the appropriate assessment by marking an X in the appropriate column in the Client Assessment of Past Performance table.

Management and Client Relationships Factor

Assessment Assessment Description

Unsatisfactory Ability to manage issues is jeopardizing performance of contract requirements, despite use of client resources. Management is unable to address the issues. Response to inquiries and/or technical, service, administrative issues is not effective. If performance cannot be substantially corrected, this level of ability to manage issues constitutes a significant impediment in consideration for future awards.

Marginal Weak management requires client resources to ensure achievement of goals: offeror not able to achieve some contract requirements or goals. Response to inquiries and/or technical, service, administrative issues is somewhat effective.

Good There are no management issues and the offeror has met the contract requirements. Response to inquiries and/or technical, service, administrative issues is consistently effective.

Very Good There are no management issues and the offeror has exceeded the contract requirements through the use of proactive or corrective actions. Response to inquiries and/or technical, service, administrative issues exceeds client expectation.

Excellent The offeror has demonstrated an excellent management client relationships performance level. It is expected that this rating will be used in those rare circumstances where the offeror demonstrated performance that clearly exceeds the performance levels described as "Very Good."

Quality of Service Factor

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Unsatisfactory Non-conformances are jeopardizing the achievement of contract requirements, despite use of client resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

Marginal Overall compliance requires minor client resources to ensure achievement of contract requirements.

Good There are no, or very minimal, quality problems; and the offeror has met the contract requirements.

Very Good There are no quality issues, and the offeror has substantially exceeded the contract performance requirements without commensurate additional costs to the client.

Excellent The offeror has demonstrated an excellent performance level that was significantly in excess of anticipated achievements and is commendable as an example for others. It is expected that this rating will be used in those rare circumstances where offeror performance clearly exceeds the performance levels described as "Very Good”.

Cost Control Factor


Unsatisfactory Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of client resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.

Marginal Ability to control cost issues requires minor client resources to ensure achievement of goals: There are no, or very minimal, cost management issues and the offeror has met the contract requirements.

Good There are no cost management issues and the offeror has met the contract requirements.

Very Good There are no cost management issues and the offeror has exceeded the contract requirements, achieving cost savings to the client.

Excellent The offeror has demonstrated an excellent performance level. It

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Attachment J-6: Labor Categories

Labor Category

Years of Experience and

Education

Requirements

Medical Services Delivery Program Manager

6+ years and a Masters Degree

or

10 + years and a Bachelor's Degree.

Demonstrated program management experience for medical services delivery programsusing managerial, technical and/or business knowledge. Experience in directing and managing internal/external resources, communications and all functional program activities to meet contract cost, schedule and performance objectives.

IT Infrastructure Technical Project Manager


or


Responsible for all aspects of the development and implementation of assigned projects and provides a single point of contact for those projects. Takes projects from original concept through final implementation. Interfaces with all areas affected by the project including end users, computer services, and client services. Defines projectscope and objectives. Develops detailed work plans, schedules, project estimates, resource plans, and status reports. Conducts project meetings and is responsible for project tracking and analysis. Ensures adherence to quality standards and reviews project deliverables. Manages the integration of vendor tasks and tracks and reviews vendor deliverables. Provides technical and analytical guidance to project team. Recommends and takes action to direct the analysis and solutions of problems.

Labor Category

Years of Experience and

Education

Requirements

Network / Communications Interface Engineer

2 + years and a Master’s Degree in Electrical Engineering or equivalent

or

5 + years and a

Demonstrated experience in the design, development, installation, testing and maintenance of communications systems and subsystems.

Experience in planning, analysis, design, testing, and troubleshooting of communications networks and related systems. Experience in solving

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Bachelor’s Degree in Electrical Engineering or equivalent

or

10+ years and a High School Diploma

system problems and workflow organization and planning. Able to install, operate and test software and hardware. Proficient with the use of various types of communications test equipment

IT Systems Architecture


or


Top-level technical expert responsible for design and development of a complex technical environment. Develops strategy of technical system and the design infrastructure necessary to support that strategy. Advises on selection of technological purchases with regards to communications, processing, data storage, data access, and applications development. Sets standards for the relational database structure for the organization.

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Labor Category Years of Experience and

Education

Requirements

Systems Engineer


or


Performs high-level systems analysis, evaluation,design, integration, documentation, and implementation of very complex application thatrequire a thorough knowledge of administrative and technical skills. Directs andparticipates in all phases of system development with emphasis on planning, analysis, evaluation, integration, testing and acceptance phases (IV&V ). Applies higher-level business or technical principles and methods to very difficult technical problems to arrive at automated engineering solution. Designs and prepares technical reports and related documentation, and makes charts and graphs to record results.Prepare and deliver presentations and briefings as required by the Task Order. May be required to serve as Task Leader. Responsible for ensuring the quality and services delivered for particular task(s) for which this skill is performing the Task Leader position.

Web/Application Programmer

Bachelor’s Degree in Electrical Engineering, Computer Science or equivalent

or

5 + years and a High School Diploma

Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time and form of desired results. Designs, codes, tests, debugs and ocuments those programs.Competent to work at the highest technical level of all phases of applications programming activities.

Designs, develops, troubleshoots, debugs, and implements software code (such as HTML, CGI, and JavaScript) for a component of the website. Works with graphic designers and other members of a project team to develop the site concept, interface design, and architecture of the website. Responsible for interface implementation. Integrates web applications with backend databases. Deploys large web-based transaction systems using application servers. Researches, tests, builds, and coordinates the integration of new products per production and client

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requirements.Requires strong navigation and site-design instincts.

Test Engineer Bachelor’s Degree in Electrical Engineering, Computer Science or equivalent

or

5 + years and a High School Diploma

Experience in development, installation, and maintenance of satellite systems and subsystems operations and testing. Has general working knowledge of industry practices, standards and technology areas. Assists in definition, analysis and allocation of requirements. Supports test programs and analyzes testing. Conducts analysis of requirements and components and supports audits conducted to ensure intended functionality and performance is achieved. Can conduct installation and maintenance of systems/equipment, and provide associated training to customer personnel. Diagnoses, isolates, and corrects problems to component level to restore system’s functions.

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