13. Exhibit K_PastPerf Questionnaire_VA-REV.docx
DOCX document 44 KB Posted
- Solicitation number
- 36C24W26R0012
- Issued by
-
Department of Veterans Affairs
About this file
This is a Past Performance Questionnaire template used to collect contractor performance evaluations for federal lease contracting purposes. The document is designated as Exhibit K and is associated with Solicitation Number 36C24W22R0053 for a VA/CBOC (Community Based Outreach Clinic) leasing requirement in the Olympia, Washington area under RPO West Leasing and VHA (Veterans Health Administration). The questionnaire is completed in two sections: Section A is filled out by the contractor being evaluated, capturing basic contractor information, contract details including award date, contract amount, period of performance, and the contractor's point of contact. Section A also requires authorization from an official to release performance information to the Lease Contracting Officer, Deborah Greer, at Deborah.Greer@va.gov.
Section B is completed by assessors and evaluates contractor performance across three primary categories using a standardized five-point rating scale (Exceptional, Satisfactory, Marginal, Unsatisfactory, or Neutral/Unknown Risk). The Quality of Service section assesses compliance with contractual requirements and overall service quality. The Schedule section evaluates timely delivery and the contractor's ability to control costs and submit accurate, complete invoices. The Business Relations section comprises five questions addressing business practices, management relationships, timeliness of required reports and invoices, responsiveness to complaint resolution, and overall business relations performance. The questionnaire also includes a subjective question regarding the assessor's willingness to award future contracts to the contractor and requires an overall performance rating with space for general comments. Assessors must identify their role (Contract Specialist/Lease Contracting Officer, Technical Project Lead, or other) and provide their contact information.
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Text version
12/30/20 Exhibit K
PAST PERFORMANCE QUESTIONNAIRE
SECTION A: Contractor Information (to be completed by the contractor for whom past performance information is being collected, prior to forwarding to assessors)
| Solicitation Number |
| 36C24W22R0053 |
| Project/Requirement |
| VA/CBOC in the Olympia, WA Area |
| Customer/Agency |
| RPO West Leasing / VHA |
| Offering Entity |
| Input Name of Offering Entity HERE |
1. Prospective Government Contractor’s Name, Company Name and Address: _____________________________________________________________________________
2. Contractor Point of Contact: ___________________________________________
3. Phone number (with area code): ___________________________________________
4. Assessor Contract Award number: _________________________________________
5. Description of Services provided under contract: ________________________________________________________________________
6. Contract award date: ___________ Contract Amount: Initial ___________Final ______________
7. Period of Performance or Delivery Date: _________________________
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
8. Authorization is hereby granted to provide the information requested in this questionnaire to RPPO West Leasing, Deborah Greer, Lease Contracting Officer, via email at Deborah.Greer@va.gov.
(Signature)
| _____________________________________________ | __________________________ | |
| (Name and Title of Authorizing Official) | (Date) |
SECTION B: Assessors Information (to be completed by assessors).
RATING SCALE Definitions Past Performance Ratings and Definitions
| E |
| Exceptional/Very Low Risk |
| Offer’s past performance record provides essentially no doubt that the offeror will successfully perform the required effort. |
| S |
| Satisfactory/Low Risk |
| Offer’s past performance record provides little doubt that the offeror will successfully perform the required effort. |
| M |
| Marginal/Moderate Risk |
| Offer’s past performance record, although satisfactory, provides some doubt that the offeror will successfully perform the required effort. |
| U |
| Unsatisfactory/High Risk |
| Offer’s past performance record provides substantial doubt that the offeror will successfully perform the required effort. |
| N |
| Neutral/Unknown Risk |
| The offeror has no relevant past performance record. A thorough search was unable to identify any past performance. Will not rate favorably or unfavorably. |
The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.
QUALITY OF SERVICE
1. Rate the contractor’s compliance with contractual requirements. _________ (E /S /M /U /N)
2. Overall rating of contractor quality of service. _________ (E /S /M /U /N)
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
SCHEDULE
1. Delivery of service was within required time period specified by contract requirements. _________ (E /S /M /U /N)
2. Rate the contractor’s ability to control cost and submit invoices.
Are invoices complete, accurate, and timely? _________ (E /S /M /U /N)
BUSINESS RELATIONS
1. Overall rating of contractor’s business practices (e.g., maintaining A positive working relationship, business ethics, timely and effectively Resolution of any problems, etc.) _________ (E /S /M /U /N)
2. Rate the working relationship between contractor’s management, and your company (i.e., contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer). _________ (E /S /M /U /N)
3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner. _________ (E /S /M /U /N)
4. Rate the contractor’s responsiveness to customer complaint resolution. _________ (E /S /M /U /N)
5. Overall rating of contractor’s business relations. _________ (E /S /M /U /N)
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
How would you feel about awarding another contract to this contractor? (Mark with an “X”)
| ______ | Would not hesitate to award another contract to this contractor. |
| ______ | Would most likely award another contract to this contractor. |
| ______ | Would think twice about awarding another contract to this contractor but would do so if no better alternative existed. |
| ______ | Do not wish to award another contract to this contractor. |
| ______ | Would not award another contract to this contractor. |
Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.
| Exceptional |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Neutral |
VII. General Comments:
ASSESSOR:
Identify your role in the contract award or administration and the period of your involvement.
| Role |
| Period of Involvement |
Contract Specialist/LEASE CONTRACTING OFFICER
Technical Project Lead/Project Officer
OTHERS
| ________________________________________ | ____________________________ | |
| (Signature) | (Date) |
(Typed or Printed Name) (Organization Name)
| ____________________________ | _________________________ | |
| (Phone Number) | (Email) |
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