36C24218Q9616-005.pdf

PAST PERFORMANCE SURVEY

OFFEROR INSTRUCTIONS: A separate record must be completed for each Past Performance

Information and Survey; Offeror must directly send to the evaluator, requesting they complete and return as indicated on the attached Past Performance Survey, by not later July 31, 2018, to

Eulanda.James@va.gov. Further, Offeror must include a copy of each requested Past Performance

Information page with quote submission.

Solicitation Number:

Name and address of Offeror:

Contract Details (i.e. Contract #/ Delivery or Task Order #, Title, Location, etc.)

Contract No.:

Contractor Name:

Date:

Title:

Location:

Type of Facility:

Assessor Full Name:

Assessor Position held or function in relation to project:

Assessor’s Company/Organization Name, Address and Phone number:

Assessor’s email address:

Please complete and return to: Eulanda.James@va.gov

PAST PERFORMANCE SURVEY

Reference Instructions: The Department of Veterans Affairs is considering the Offeror listed above for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive. Survey should be completed by the evaluator and returned to Eulanda.James@va.gov not later than the above date.

Please evaluate the Past Performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, provide additional information in the appropriate block or in the remarks section of this form.

O = Outstanding = Performance greatly exceeded contract requirements

A = Above Average = Performance exceeded contract requirements

S = Satisfactory = Performance met contract requirements

M = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.

U = Unacceptable = Performance was poor and/or did not satisfy contract requirements

NOTE: Do not use a color marking pen to circle the response. Best to use a ball point pen

(Black or Blue) to circle your response.

Describe exactly what type of janitorial services or similar service(s) were provided to your company/organization?

Period of Performance (Provide dates):

Rate the following questions if the company provided janitorial services.

Provide information/comments in the Remarks Section below.

Circle One

Q1. To what extent did the contractor comply with contract requirements?

O A S M U

Remarks:

Q2. How timely was the contractor’s performance? O A S M U

Q4. Rate the effectiveness of the contractor’s management of the contract?

Q6. Rate the contractor’s personnel management practices. O A S M U

Q7. Quality Control: Rate the overall quality of contractor’s work. O A S M U

Q8. To what extent did the contractor meet performance schedule? O A S M U

Q9. What extent was contractor flexible in responding to changing needs?

Q10. To what extent was the contractor reliable? O A S M U

Q12. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, explain on the following page.

Yes No

Q13. Would you award another contract to this contractor? If no, explain on the following page.

Q14. Was the customer satisfied with the service provided? If no, explain on the following page.

Q15. To what extent did contractor notify you of problems of potential issues?

Q16. Did the Contractor perform in a professional manner? Yes No

Q17. Did the Contractor demonstrate good customer service skills? Yes No

Q18. Did the Contractor require a significant amount of oversight to ensure the service was rendered in accordance with applicable regulations?

Yes No

Remarks:

PAST PERFORMANCE SURVEY – REMARKS SECTION

Additional Remarks regarding janitorial services:

Signature: Date:

Print Name:

Please email directly to Eulanda.James@va.gov

DO NOT return survey to the company you are evaluating.