36C24519R0111-009.pdf

ATTACHMENT 5 - PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION NO. 36C24519R0111

The offeror shall provide the following questionnaire to three to five references who can attest to the offeror’s performance covering contracts or jobs that are recent, that is within three years, and relevant, that is of the same type and scope of work. The offeror shall provide a list of these references, including the company/agency name, Point of Contact (POC), and telephone number or email address of the POC as part of their proposal to be considered for award. Information to substantiate the relevancy and recency regarding the references must also be included. Offerors should instruct their chosen references that completed questionnaires must be submitted by the exact date and time specified for receipt of offers, that is shown on the SF1442, to Shawn E. Shafer (Shawn.Shafer2@va.gov), 1 Med Center Drive, Clarksburg, WV 26301.

PART 1: Shall be completed by the prospective contractor prior to forwarding to prospective contractor's past performance reference.

1. Prospective Contractor's Name and Address

2. Prospective Contractor's Point of Contact with Name and Title

3. Prospective Contractor's Telephone Number (with area code)

4. Prospective Contractor's E-mail Address and/or facsimile Telephone Number

5. Prospective Contractor's Client, Firm or Government Agency Reference Name and Address

6. Prospective Contractor's Client, Firm or Government Agency Reference Telephone Number (with area code)

7. Contract Number of the Work Performed by the Prospective Contractor for Client, Firm or Government Agency and the Amount of the Award.

8. Brief Description of Relevancy of Work Involved

9. Contract/Order Period of Performance (list original contract periods such base year and 3 option periods)

PART 2: Shall be completed by Prospective Contractor's Client, Firm or Government Agency Reference.

1. Name and Title of Reference

2. Signature of Reference

3. Date

4. Name of Client, Firm or Government Agency Reference

5. Telephone Number

6. Facsimile Telephone Number

7. Reference E-mail Address

RATING DEFINITIONS for Trade Off:

Acceptable: Contractor’s performance met or exceeded minimum contract requirements with no problems or with few problems that were immediately corrected by the contractor to the satisfaction of customer. The risk associated with this rating is considered moderate.

Unacceptable: Contractor performance failed to meet 1 or more contract requirements that were not corrected to the satisfaction of the customer or not corrected in a timely manner.

Neutral: The rater has no knowledge of the contractor’s performance for the rating element or the offeror has indicated they have no relevant past performance history for work similar in size and scope within the past three years.

QUALITY OF SERVICES

Evidence of Compliance with Contract Requirements:

Rate the contractor’s compliance with contract terms, conditions or requirements.

□ (Acceptable)

□ (Unacceptable)

□ (Neutral)

Comments (Optional):

Accuracy of Reports:

Rate the contractor’s accuracy of the contractor reports.

□ (Acceptable)

□ (Unacceptable)

Technical Excellence:

Rate the contractor’s technical ability.

□ (Acceptable)

□ (Unacceptable)

Quality Workmanship:

Rate the contractor’s quality of workmanship.

□ (Acceptable)

□ (Unacceptable)

Resolution of Problems:

Rate the contractor’s ability to resolve any unforeseen problems.

□ (Unacceptable)

TIMELINESS OF SERVICE

Delivery schedule:

Rate the contractor’s ability to provide continuous, on-time delivery in accordance with the established delivery schedule.

□ (Acceptable)

□ (Unacceptable)

BUSINESS RELATIONS

Reasonable and Cooperative Behavior:

Rate the contractor’s reasonable and cooperative behavior.

□ (Acceptable)

Flexibility:

Rate the Contractor’s Flexibility.

Effective Conflict Resolutions:

Rate the contractor’s ability to resolve conflict.

□ (Acceptable)

□ (Unacceptable)

Ability to Handle Government Requests for Change:

Rate the contractor’s ability to respond to changes.

□ (Acceptable)

□ (Unacceptable)

Communication:

Rate the contractor’s communication of performance progress, to include any notification of potential problems.

□ (Acceptable)

CONTRACTOR’S OVERALL RATING:

Rate the contractor’s overall performance.

□ (Acceptable)

□ (Unacceptable)