36C10G19Q0086-006.docx
DOCX document 18 KB Posted
- Attached to
- NX EQ Vitrectomy Units (VA-19-00048291)
- Solicitation number
- 36C10G19Q0086
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36C10G19Q0086 Attachment F Past Performance Questionnaire.docx
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| File | Type | Posted |
|---|---|---|
| 36C10G19Q0086-002.docx | DOCX document | |
| 36C10G19Q0086-001.xlsx | XLSX spreadsheet | |
| 36C10G19Q0086-003.docx | DOCX document | |
| 36C10G19Q0086-000.docx | DOCX document | |
| 36C10G19Q0086-005.xlsx | XLSX spreadsheet | |
| 36C10G19Q0086-004.docx | DOCX document |
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Past Performance Questionnaire
SOLICITATION NO: 36C10G19Q0086
DESCRIPTION: Non-Expendable Equipment Alcon Constellation Vitrectomy Units
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
| TO: | Name of reference, Title of reference | |
| E-MAIL: | Email address of reference |
VA SAC is currently in the process of awarding a requirements contract for the solicitation described above. The Vendor identified below has provided your organization’s name as a reference under the contract described below:
Vendor Name
Contract Number
Please rate the Vendor in each of the categories on this questionnaire. See “Rating Guidelines” section for detailed description of categories and ratings. There is room for comments where you deem remarks would be helpful to our evaluation (see ‘Comment from Reference’ under “Vendor Evaluation”. Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this Vendor’s past performance. Thank you for your organization’s assistance.
Please E-mail Questionnaire to Carlina Smith at Carlina.Smith@va.gov by 2:00 pm EST June 27, 2019.
Name of Reference
Phone Number:
E-Mail Address:
Name of Organization:
Contract Period of Performance (Month/Day/Year Begin and End):
Total Contract Value (Base and All Option Years):
Options Exercised on Contract (Yes/No)?
Brief Description of Services/Commodities Provided by Vendor
Show Cause Order Issued on Contract (Yes/No)?
Stop Work Order Issued on Contract (Yes/No)?
Termination for Convenience, Cause, or Default Issued on Contract (Yes/No)?
Rating Guidelines:
| Rating |
| Quality of Service |
| Cost Control |
| Timeliness of Performance |
| Business Relations |
| 0: Unsat |
| Was not in compliance and jeopardized achievement of contract objectives |
| Was unable to manage costs effectively |
| Had delays which jeopardized performance |
| Response to inquiries and issues was not effective |
| 1: Poor |
| Major problems were encountered |
| Had major difficulty managing costs effectively |
| Had major difficulty meeting milestones and delivery schedule |
| Response to inquiries and issues was marginally effective |
| 2: Sat |
| Some problems were encountered |
| Had some problems managing costs effectively |
| Had some problems meeting milestones and delivery schedule |
| Response to inquiries and issues was somewhat effective |
| 3: Good |
| Minor inefficiencies and errors were identified |
| Was usually effective in managing costs |
| Was usually effective in meeting milestones and delivery schedule |
| Response to inquiries and issues was usually effective |
| 4: Excellent |
| Was in compliance with contract requirements and delivered quality products/services |
| Was effective in managing costs and submitted proper invoices |
| Was effective in meeting and exceeding milestones and delivery schedule |
| Response to inquiries were effective and/or exceeded expectations and established deadlines |
Vendor Evaluation:
| Rating (List Number Based on Rating Guidelines Above) |
| Category |
| Description |
| Quality of Service |
| Complied with contract requirements, submitted accurate reports/deliverables, had effective personnel, and achieved/maintained technical excellence: |
Comment from Reference: _________________________________________
| Cost Control |
| Achieved efficiencies in costs, managed costs effectively, and submitted timely/accurate invoices with supporting documentation: |
| Timeliness of Performance |
| Met milestones, was reliable and responsive to technical direction, and completed milestones on-time or ahead of schedule: |
Comment from Reference: _________________________________________
| |_| YES |_| NO |
| Overall Satisfaction |
| Would you choose to work with this Vendor again? |
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