36C10G20R0014-033.docx
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- Solicitation number
- 36C10G20R0014
About this file
This notice provides information for an upcoming solicitation from the Department of Veterans Affairs for Community Care Network services in Alaska. The solicitation will seek a contractor to establish and maintain a provider network to deliver a range of medical, surgical, dental and other healthcare services to eligible Veterans throughout Alaska. Services will include claims processing and payment. The solicitation is anticipated to be a single-award Firm Fixed Price IDIQ contract with a nine-month base period and seven one-year options. The VA intends to post the final RFP on May 11th, 2020, with proposals due on June 1st, 2020. The anticipated NAICS code is 524292.
36C10G20R0014 CCN Region 5 Attachment 4 - Past Performance Questionnaire .docx
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ATTACHMENT [_]: PAST PERFORMANCE QUESTIONNAIRE (PPQ)
REQUEST FOR PROPOSAL (RFP) NO.: [insert RFP number]
INFORMATION REQUEST: PAST PERFORMANCE QUESTIONNAIRE
The Department of Veterans Affairs (VA) is currently in the process of awarding a competitive service contract. VA intends to acquire Community Care Network (CCN) services and healthcare resources, purchased under the authority of 38 United States Code (U.S.C.) § 8153, “Sharing of Health-care Resources.” VA intends to honor this commitment by improving performance, promoting a positive culture of service, increasing operational effectiveness and accountability, advancing healthcare innovation through research, and training future VA clinicians.
[Offeror’s Name]has identify you as the Government POC in their past performance volume for Contract/BPA/Task Order [insert number].
A. CONTRACT INFORMATION
This reference questionnaire is being completed for the Prime |_| or Subcontractor |_|.
Contractor/Prime: _______________________________________________________
Subcontractor: _________________________________________________________
Contract/BPA/Task Order No: _____________________________________________
Type of Contract: |_| Firm-Fixed Price |_| Cost |_| Other: ________________________
Acquisition Strategy: |_| Negotiated |_| Sealed Bidding
Competition: |_| Competitive |_| Non-Competitive
Award(s): |_| Single |_| Multiple
Provide a brief description of the services provided by the contractor for this contract: ____________________________________________________________________________________________________________________________________________
Period of performance (i.e., when were services provided):
From: ____________________________ To: ______________________________
Obligated dollar value: ___________________________________________________
B. RATER INFORMATION
Name of person contacted/completing the evaluation: __________________________
Telephone: ___________________________ E-mail: __________________________
Title of person contracted/completing the evaluation: ___________________________
Length of Involvement with Contract/BPA/Task Order: __________________________
Date Questionnaire Completed: ____________________________________________
Please rate the contractor 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
· 1: Performance clearly below the contract performance standard or requirement
| · 2: | Performance occasionally does not meet minimum contract performance standard or requirement |
| · 3: | Performance that meets the minimum contract performance standard or requirement |
| · 4: | Performance that meets and occasionally exceeds the contract performance standard or requirement |
| · 5: | Performance that almost always exceeds the contract performance standard or requirement |
| 1. Overall quality/satisfaction |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Overall satisfaction with the Contractor’s performance.
| 2. Delivery performance |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.
| 3. Satisfaction with the quality of service delivered |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.
| 4. Satisfaction with problem resolution |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
This includes the contractor’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.
| 5. Satisfaction with the quality of contractor personnel |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the quality of the contractor’s staff in executing the project work scope.
6. If a subcontracting plan was required, did the contractor meet applicable goals for small business participation? |_| Yes |_| No If No, please explain.
7. Have you issued a contractor discrepancy report, 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.
8. Have you terminated this contractor partially or completely for default or convenience within the past 3 years, or are there any pending termination actions? |_| Yes |_| No If Yes, please explain.
9. Have you discussed any adverse past performance problems with the contractor and given them an opportunity to comment? |_| Yes |_| No If Yes, please explain.
10. If the contract had options, were those options exercised? |_| Yes |_| No If No, please explain.
11. Based on the contractor’s overall performance, would you award them another contract? |_| Yes |_| No If No, please explain.
12. Is there any additional information on contractor’s performance you would like to provide? |_| Yes |_| No If Yes, please explain.
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