3- PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 24 KB Posted
- Solicitation number
- 36C24826Q1106
About this file
This is a Past Performance Questionnaire template designed for evaluating contractor performance on federal contracts. The form requires offerors to provide contract information including the contractor name, contract number, contract title, contract type, and period of performance. The questionnaire uses a rating system to assess six key performance elements: Technical (quality of product or service), Schedule (timeliness against milestones and delivery schedules), Cost Control (cost forecasting, management, and invoice accuracy), Business Relations (coordination, problem identification, corrective action, and customer satisfaction), Management of Key Personnel (assessment of contractor staff), and an Overall Rating.
The form includes a section for remarks on any unsatisfactory performance with supporting data, and asks whether the reference would do business with the offeror again. The questionnaire must be completed by a reference source (not the offeror) who provides their name, title, mailing address, telephone number, and date. A VA employee must also complete and sign the form, certifying their name, title, date, and signature. According to the related solicitation 36C24826Q1106 for Roof Top Replacement (RTU) units at the West Palm Beach VA Medical Center, contractors are required to submit three completed Past Performance Questionnaires as part of their proposal submission.
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Other files
| File | Type | Posted |
|---|---|---|
| York Unit Description - VA WPB Cancer Center RTU-3 8.14.25.docx | DOCX document | |
| VA WPB Cancer Center RTU-3 DrawingREV08-15.pdf | ||
| 36C24826Q1106_2.docx | DOCX document | |
| VA WPB Cancer Center RTU-3 - AHU Performance reportR1.pdf | ||
| 36C24826Q1106_1.docx | DOCX document | |
| ANSWERS TO CONTRACTOR QUESTIONS.pdf | ||
| 1- Combined Synopsis.pdf | ||
| 36C24826Q1106.docx | DOCX document | |
| 3a- PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| 2- Statement of Work RTU Replacement Unit.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Name of offeror:
Contract Information:
Name of Contractor: Contract Number:
Contract Title:
Type of Contract: Period of Performance:
The ratings indicated below are to be supplied by the reference and not the offeror)
| Performance Elements |
| Satisfactor y |
| Unsatisfacto ry |
1. Technical (Quality of Product or Service) (evaluation of the contractor’s technical performance or progress toward meeting requirements)
2. Schedule (evaluation of the timeliness of the contractor against milestones, delivery schedules)
3. Cost Control (evaluation of the contractor’s effectiveness in forecasting, managing, controlling cost and submitting accurate invoices)
4. Business Relations (assess the integration and coordination of all activity needed to execute the work, specifically the timeliness, completeness and quality of problem identification, corrective action, the contractor’s history of reasonable and cooperative behavior, customer satisfaction)
5. Management of Key Personnel (assess the contractor’s personnel performing the work)
6. Overall Rating
Remarks on unsatisfactory performance (Provide data supporting this observation. You may continue on separate sheet if needed.)
Would you do business with the offeror again?
Information provided by:
Name of Source: Title: Mailing Address: City, State and Zip Code: Telephone Number: Date:
Questionnaire completed by:
Name of VA Employee: Title:
Date: Signature:
File details come from the government source that posted it. Updated .