ATTACHMENT B - CASE CARTS - PAST PERFORMANCE QUESTIONNAIRE.pdf

ATTACHMENT B

PAST PERFORMANCE QUESTIONNAIRE

NX EQ Case Carts

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 and DELIVERY/TASK ORDER].

Past Performance Questionnaire

Offeror’s Name: ______________________________________________________________

Solicitation: Non-Expendable Equipment – Case Carts

Name of Person Completing the Evaluation: _______________________________________ Telephone: _____________________E-Mail: ______________________________________ Title_____________________ Company/Organization: _______________________________ Award Value: $____________________ Name of Commodity/Service____________________ Date Awarded_____________________

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

1. Quality of Performance: N/A M A G O

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

2. Timeliness of Performance: N/A M A G O

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

3. Price/Price Control: N/A M A G O

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

4. Customer Satisfaction N/A M A G O

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:

Rating (List Number Based on Rating Guidelines Above)

Category Description

Quality of Service

In compliance with contract requirements, submits accurate reports/deliverables, has effective personnel, and has achieved/maintained technical excellence:

Comment from Reference: _______________________

Cost Control Has achieved efficiencies in costs, managed costs effectively, and has submitted timely/accurate invoices with supporting documentation:

Comment from Reference: _______________________

Timeliness of Performance

Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule:

Comment from Reference: _______________________

Business Relations

Has maintained effective management of contract, has exhibited reasonable/cooperative behavior, is responsive to contract requirements, is responsive to inquiries/issues, and is proactive about resolving problems:

Comment from Reference: _______________________

YES NO Overall Satisfaction

Would you (reference) choose to work with this offeror again?

Comment from Reference: _______________________

PART III. RETURN INFORMATION

Please return this completed Past Performance Questionnaire AS AN ATTACHMENT via e-mail to Tonya W. Purce at tonya.purce@va.gov and David Barber david.barber@va.gov in PDF format. The subject line of the email must read:

RFQ 36C10G22R0011 - NX EQ Case Carts Past Performance Questionnaire in order for the email to be successfully transmitted and received.

Signature of Rater mailto:tonya.pruce@va.gov mailto:tonya.pruce@va.gov mailto:Robert.Wilson11@va.gov mailto:Robert.Wilson11@va.gov