36C10X19Q0061-0001001.docx

AGENCY: Department of Veterans Affairs, Strategic Acquisition Center - Frederick TO: Melissa Maloy, Contracting Officer Rebecca Ubert, Contract Specialist

RFQ: 36C10X19Q0061

TITLE: NDIP

PHONE: 202-770-6584

E-MAIL: Rebecca.Ubert@va.gov & Melissa.Maloy@va.gov

INFORMATION REQUEST: PAST PERFORMANCE

This office is currently in the process of awarding a competitive Blanket Purchase Agreement. ________ [INSERT CONTRACTOR NAME] has provided your name and organization as a reference regarding _ [INSERT CONTRACTOR NAME]’s record of past performance under Contract No. _____________________ [INSERT CONTRACT NO.].

PAST PERFORMANCE QUESTIONNAIRE

Contractor Name:

Name of Person Completing the Evaluation:

Telephone: E-mail:

Title:

Company/Organization:

Past Performance Effort/Contract:

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

Overall satisfaction with the Contractor’s performance.

Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.

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

This includes the Contractor’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.

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

6. 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.

7. 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.

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

|_| Yes |_| No If No, please explain.

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

10. Do you file past performance information in a database that the Contracting Officer may search?|_| Yes |_| No If yes, what database?

11. If the contract had options, were those options exercised? |_| Yes |_| No If no, please explain.

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

13. What was the dollar value of the contract performed by the Contractor?

14. 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.