36C10G18Q0157-006.docx

ATTACHMENT F – ANALYTICAL BALANCES

PAST PERFORMANCE ASSESSMENT QUESTIONNAIRE

This office is currently in the process of awarding a competitive service contract. [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR’S NAME] record of past performance under Contract No. [CONTRACT NO.].

Offeror’s Name: ______________________________________________________________

Solicitation: Non-expendable Equipment –Analytical Balances - 36C10G-18-Q-0157

Name of Person Completing the Evaluation: _______________________________________ Telephone: _____________________E-Mail: _______________________________________ Title_____________________ Company/Organization: _______________________________

Please rate the Offeror in each of the following areas. Note there is room for comments where you deem remarks would be helpful to our evaluation.

· Not Applicable – N/A

· Marginal (M) Performance did not meet some contractual requirements

· Acceptable (A) Performance that meets the minimum contract performance standard or requirement

· Good (G) Performance that meets and occasionally exceeds the contract performance standard or requirement

· Outstanding (O) Performance that almost always exceeds the contract performance standard or requirement

Compliance with contract requirements, use of appropriate and helpful staff, and expertise in the accreditation of medical laboratories as a deemed organization.

The Offeror’s ability to meet milestones and delivery schedules.

The Offeror’s ability to control prices claims; change order issues.

The Offeror’s commitment to customer satisfaction and their cooperative, reasonable businesslike behavior. This includes effective management, responsiveness to contract requirements, honesty and integrity, prompt notification of problems, flexible and proactive qualities and effective subcontract selection and management.

5. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years? [ ] YES [ ] NO If yes, please explain.

6. Have you terminated this Contractor for default within the past 3 years, or are there any pending termination actions? [ ] YES [ ] NO If yes, please explain.

7. Based on the Offeror’s overall performance, would you award them another contract?

[ ] YES [ ] NO If no, please explain.

8. Have you discussed any adverse past performance problems with the Offeror and given them an opportunity to comment? [ ] YES [ ] NO Please explain Offeror Evaluation:

Comment from Reference: _______________________

PART III. RETURN INFORMATION

Please return this completed Past Performance Questionnaire AS AN ATTACHMENT via e-mail to Ninatile Bacote at Ninatile.bacote@va.gov in PDF format. The subject line of the email must read: RFQ 3610G18Q0157 - NX EQ Analytical Balances - Past Performance Questionnaire in order for the email to be successfully transmitted and received. Please e-mail the completed questionnaire by 2:00PM EST on May 30, 2018.