36C10X23R0006 - Attachment C - Past Performance Questionnaire.pdf

36C10X23R0006 Past Performance Questionnaire

AGENCY: Department of Veterans Affairs, Strategic Acquisition Center - Frederick

RFP: 36C10X23R0006 WHITE HOUSE PRIORITY GOALS SUPPORT 1, 2, and 3

TO:

PHONE:

E-MAIL:

INFORMATION REQUEST: PAST PERFORMANCE

The Department of Veterans Affairs is currently in the process of awarding a competitive service contract.

Please send completed questionnaires to

NOTE TO RESPONDENTS: If the Questionnaire is provided for a subcontractor’s reference, the contractor’s name below must include both the subcontractor’s name and the offeror’s name who will be the prime contractor for this solicitation (e.g. contractor X, who will be a subcontractor to offeror Y for this solicitation).

Vendor’s Name

Name of Person Completing the Evaluation:

Telephone:

E-mail:

Title:

Company/Organization:

Instructions:

Please rate the vendor in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.

• Exceptional: Performance that almost always exceeds the contract performance standard or requirement

• Very Good: Performance that meets and occasionally exceeds the contract performance standard or requirement

• Satisfactory: Performance that meets the minimum contract performance standard or requirement

• Marginal: Performance occasionally does not meet minimum contract performance standard or requirement

• Unsatisfactory: Performance clearly below the contract performance standard or requirement

• Not Applicable: N/A

Performance Areas Exceptional Very Good

Satisfactory Marginal Unsatisfactory N/A

1. QUALITY ☐ ☐ ☐ ☐ ☐ ☐

Comments: Assess the achieved service performance relative to performance parameters required by the contract or order.

2. SCHEDULE ☐ ☐ ☐ ☐ ☐ ☐

Comments: Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance).

3. COST CONTROL (Not required for Fixed Price type contracts or orders)

Comments: Assess the Contractor’s effectiveness in forecasting, managing, and controlling contract or order cost.

4. MANAGEMENT ☐ ☐ ☐ ☐ ☐ ☐

Comments: Assess the integration and coordination of all activity needed to execute the contract or order, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the Contractor’s history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts.

5. UTILIZATION OF

SMALL BUSINESS

Comments: Assess compliance with all terms and conditions in the contract or order relating to Small Business participation (including FAR 52.219-8 Utilization of Small Businesses, and FAR 52.219-9 Small Business ☐Subcontracting Plan, when required).

6. REGULATORY

COMPLIANCE

Comments: E.g failure to report in accordance with contract terms and conditions, late or nonpayment to subcontractors, trafficking violations, tax delinquency, defective cost or pricing data, terminations, suspension and debarments. Assess compliance with all terms and conditions in the contract/order relating to applicable regulations and codes, using the Evaluation Ratings Definitions.

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

8. What was the dollar value of the contract performed by the vendor?

9. Provide a brief description of the services provided by the vendor for this contract.

10. Overall Recommendation Would Would Not Signed

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I _________________ award to him today given that I had a choice.

36C10X23R0006 Past Performance Questionnaire