36C24519Q0334-003.pdf

Source Selection Information—See FAR 2.101 and 3.104

Past Performance Questionnaire

The Department of Veterans Affairs is evaluating an offer from ___________________ [Offeror’s name], hereafter referred to as “Offeror,” to provide Bulk Laundry Services services for the Washington DC VA Medical Center. Offeror has provided this questionnaire to you so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.

Any information you provide in this questionnaire is considered Source Selection Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release your name or the names of other individuals providing reference information about Offeror’s past performance.

Instructions: Be honest. Provide an assessment of Offeror’s past performance by checking the box of one the following rating options. You are encouraged to write comments as often as you’d like.

Rating Options:

Satisfactory - Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.

Unsatisfactory - Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.

Neutral - Unable to provide a meaningful assessment.

When you are finished, please email your completed questionnaire to James.Whisner@va.gov.

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!

Performance Assessment

1. Reference Information

Your Company’s Name: _________________________________________________________________

Your Name: __________________________________________________________________________

Contract Number (if Government): ________________________________________________________

Period of Performance: Start Date: _______________________ End Date: ________________________

Scope of Services (e.g., types of services provided—e.g., healthcare bulk laundry or other, amount of laundry cleaned per year (more or less than a million pounds?), pickup/delivery frequency, contract dollar value, etc.):

2. Performance Rating

a. Quality of performance

Satisfactory Unsatisfactory Neutral Conformance to contract specifications

Customer satisfaction

Quality of workmanship (e.g., laundry items cleaned, sanitary, free of stains, excess wrinkles, unserviceable/torn items packaged separately & reported, etc.)

Timeliness of pick-ups and deliveries; timely submittal of reports and other documentation

Comments regarding performance quality

b. Management performance

Satisfactory Unsatisfactory Neutral Management responsiveness (timeliness, reliability, cooperation, etc.)

Management of personnel (hiring, training, retaining, replacing, etc.)

Management of conflicts or issues (reactive, provides good solutions, flexible to changing needs, etc.)

Comments regarding management performance

Assessor’s Signature: _____________________________________ Date: _____________________

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!