Attachment 8 - Past Performance Questionnaire.pdf

Attachment 8 36C10G22R0013

Department of Veterans Affairs:

INFORMATION REQUEST: PAST PERFORMANCE QUESTIONNAIRE

The Department of Veterans Affairs is currently in the process of awarding a competitive enterprise wide strategic contract for Standard Manual Wheelchairs and Accessories for in home use. This Questionnaire has been sent to you for a reference for solicitation:

Send completed questionnaires to darrell.williamson@va.gov and zachary.wilcox@va.gov.

Please fill the subject line of the e-mail as: [Company Name] – Past Performance Questionnaire– [Insert Solicitation Number].

NOTE TO CONTRACTORS: If the Questionnaire is provided for Subcontractors reference, the Contractor’s name below must include both the Prime and Subcontractor Names.

PAST PERFORMANCE QUESTIONNAIRE

Contractor’s Name:

Subcontractor’s Name (if applicable):

BPA/Contract/Task Order Number:

Name of Person Completing the Evaluation:

Telephone: E-mail:

Title:

Company/Organization:

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 mailto:darrell.williamson@va.gov mailto:zachary.wilcox@va.gov

• 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

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

Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.

4. Satisfaction with problem resolution

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

Rate the quality of the contractor’s staff in executing the project work scope.

7. 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.

8. 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.

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

Yes No If No, please explain.

10. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? Yes No Please explain.

11. Do you file past performance information in a database that the Contracting Officer may search? Yes No Please explain.

12. If the contract had options, were those options exercised? Yes No

Please explain.

13. What was the contract period of performance (i.e., when were services provided)?

14. What was the dollar value of the contract performed by the contractor?

15. Provide a brief description of the services provided by the contractor for this contract.

Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Contractor’s past performance by the evaluator. Please provide information on any adverse performance by the contractor and the corrective actions taken.