36C24519Q0426-002.pdf

Past Performance Questionnaire

The Department of Veterans Affairs is evaluating a proposal submitted by _________________________

[Offeror’s name], hereafter referred to as “Offeror,” to provide hazardous waste removal services for the DC VA Health Care System. Offeror has provided your name 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 the 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. If your assessment is “Excellent” or “Unacceptable,” then please provide a brief narrative that explains your rationale for the rating.

When you are finished, please email your completed questionnaire to Amy Ritchey, Email:

amy.ritchey@va.gov

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!

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.

Marginal—Offeror’s performance meets (or met) some contractual requirements and performance was accomplished with frequent problems, issues or concerns, for which Offeror’s corrective actions were somewhat 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.

Not Applicable—Unable to provide a meaningful assessment.

Source Selection Information—See FAR 2.101 and 3.104

Performance Assessment

1. Quality of performance

a. What is your overall assessment of the quality of Offeror’s performance?

Satisfactory Marginal Unsatisfactory N/A

Comments:

b. Assess Offeror’s quality of performance in these areas:

Satisfactory Marginal Unsatisfactory

Conformance to contract requirements

Standards of workmanship (technical, professional, safety, etc.)

Comments:

2. Management performance

a. What is your overall assessment of Offeror’s ability to meet contract requirements?

Satisfactory Marginal Unsatisfactory N/A

Comments:

b. Assess Offeror’s contract management performance in these areas:

Satisfactory Marginal Unsatisfactory N/A

Management responsiveness (timeliness, reliability, cooperation, etc.)

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

Management of program (coordination, use of resources, communication, risk management, etc.)

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

Comments:

3. Cost control

a. What is your overall assessment of Offeror’s ability to forecast, manage and control costs?

Satisfactory Marginal Unsatisfactory N/A

Comments:

b. Assess Offeror’s cost control performance in these areas:

Satisfactory Marginal Unsatisfactory N/A

Cost/Price Estimates (ability to meet forecasted costs/prices)

Invoicing accuracy and timeliness of invoice submission

Comments:

4. General comments

Assessor’s Signature:_____________________________________ Date:_____________________

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!