Attachment D June 23 2021- Past Performance Questionairre.pdf
PDF 112 KB Posted
- Attached to
- Home Oxygen West, VISN 4 Federal contract opportunity
- Solicitation number
- 36C24421R0068_1
About this file
This document contains a past performance questionnaire for evaluation of offerors for a Department of Veterans Affairs home oxygen supplies and services contract. The solicitation is a competitive set-aside for Service Disabled Veteran Owned Small Businesses and requires experienced and licensed staff to provide home setups, deliveries, and visits. Evaluators are asked to rate offerors on compliance with contract and labor requirements, management effectiveness, and quality control using very relevant, relevant, somewhat relevant, and not relevant scales. Additional questions address the relevancy of evidence submitted to support performing to schedules when responding to changing needs, demonstrating reliability in areas such as correcting deficiencies and billing, and contract management including performance improvement and subcontractor oversight. The questionnaire also asks if cure notices, show cause letters, suspensions of payment, or terminations have been issued and whether the evaluator would award to the party, was the customer satisfied, and if problems were disclosed.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment A_FINAL 07.19.2021-Schedule CLIN.xlsx | XLSX spreadsheet | |
| 36C24421R0068 0003.pdf | ||
| PWS__FINAL 07.19.2021.pdf | ||
| 36C24421R0068 0002.pdf | ||
| QUESTIONS ANSWERS West O2.docx | DOCX document | |
| Attachment A July 19 2021-Schedule CLIN.xlsx | XLSX spreadsheet | |
| SF30 36C24421R0068 0001.pdf | ||
| Attachment A June 23 2021-Schedule CLIN.xlsx | XLSX spreadsheet | |
| Attachment B June 23 2021-DOL Wage Rates.pdf | ||
| 36C24421R0068 0001 Amendment June 23 2021.pdf | ||
| Attachment C June 23 2021- Appendix A 6500.6 PWS.pdf | ||
| Attachment D- Past Performance Questionairre.pdf | ||
| 36C24421R0068 RFP.pdf | ||
| Attachment A-Schedule CLIN.xlsx | XLSX spreadsheet | |
| Attachment C - Appendix A 6500.6 PWS.pdf | ||
| Attachment B- DOL Wage Rates.pdf |
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Text version
PAST PERFORMANCE QUESTIONAIRRE
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; This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104 Survey should be completed by evaluator and returned no later than the above date to sarah.keefer@va.gov.
Please evaluate the past performance using only the following ratings without variation. If the rating is SR or NR, please provide additional information in the appropriate block or in the remarks section of this form.
“V” = Very Relevant = Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.
“R” = Relevant = Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.
“SR” = Somewhat Relevant = Present/past performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.
“NR” = Not Relevant = Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires.
Please rate and provide information/comments for the following based on the proposal for present and past performance:
Circle one
Q1. To what extent did the contractor comply with contract requirements? V R SR NR
Q2. How timely was the contractor’s performance? V R SR NR
Q3. How well did the contractor comply with labor and safety standards? V R SR NR
Q4. Rate the effectiveness of the contractor’s management of the contract. V R SR NR
Q5. Rate the contractor’s handling of staff integrity issues. V R SR NR
Q6. Rate the contractor’s personnel management practices. V R SR NR
Q7. Quality control: Rate the overall quality on the contractors work. V R SR NR mailto:sarah.keefer@va.gov
Please rate and provide information/comments for the following: Circle one
T1. Did the contractor submit relevant present and past supporting evidence to meet the performance schedule listed in the PWS?
Rate the relevancy for the following per what was submitted.
1. Experienced and licensed staff
2. Home setups
3. Deliveries
4. Home visits
Yes No
1. V R SR NR
2. V R SR NR
3. V R SR NR
4. V R SR NR
T2. Did the contractor submit relevant present and past supporting evidence to support the PWS in responding to changing needs?
Rate the relevancy for the following per what was submitted.
1. Emergencies
2. Adherence to timeliness
T3. Did the contractor submit relevant present and past supporting evidence to support the PWS to their contractor reliability?
Rate the relevancy for the following per what was submitted.
1. Correcting deficiencies
2. Maintenance
3. Billing and Correct Coding
3. V R SR NR
T4. Did the contractor submit relevant present and past supporting evidence to support the PWS in contract management?
Rate the relevancy for the following per what was submitted.
1. Performance improvement
2. Use and control of sub-contractors
T5. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
Yes No
C1. Would you award another contract to the party being evaluated? If no, please explain:
C2. Was the customer satisfied with the end product? If no, please explain:
C3. Did the contractor submit relevant present and past supporting evidence to show the customer of any problems or potential problems?
Additional Remarks:
Additional Remarks:
Name of Evaluator:
Evaluator’s Company/Organization:
Date:
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