S06 Past Performance Questionnaire.rtf
RTF text file 207 KB Posted
- Attached to
- V225--Ambulance Transportation Services Federal contract opportunity
- Solicitation number
- 36C24525R0098
About this file
This document is a Past Performance Questionnaire template used by the Department of Veterans Affairs (VA) for evaluating contractor performance. The form is designed to collect detailed feedback on a contractor's performance across multiple dimensions, including quality of service, schedule adherence, and business relations. The evaluation uses a binary rating scale of "Acceptable" (A) or "Unacceptable" (U) for various performance categories such as contractual compliance, delivery timing, cost control, invoice accuracy, and overall business practices.
The questionnaire is specifically associated with Solicitation Number 36C24525R0098 for Ambulance Transportation Services, issued by the VA Veterans Integrated Service Network 5 (VISN 5). The document provides a structured format for assessors to rate a contractor's performance and provide rationale for their ratings, with sections for detailed commentary on the contractor's working relationship, responsiveness, and likelihood of future contract awards. The due date for this solicitation has been extended to September 16, 2025, and the document includes provisions for capturing comprehensive performance feedback from the government's perspective.
Text of this file
ATTACHMENT E: PAST PERFORMANCE QUESTIONNAIRE
PAST PERFORMANCE QUESTIONNAIRE
SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to assessors)
Solicitation Number
Project/Requirement
Customer/Agency Department of the Veteran Affairs, NCO 5
Prospective Government Contractor’s Name and Address:
| Contractor Point of Contact: |
| Phone number (with area code): |
| Assessor Contract Award number: |
| Description of Services provided under contract: |
| Contract award date: | Contract Amount: Initial | Final |
| Period of Performance or Delivery Date: |
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
Authorization is hereby granted to provide the information requested in this questionnaire to NCO 5 Network Contracting Office
(Signature)
(Name and Title of Authorizing Official) (Date) SECTION B: Assessors Information (to be completed by assessors.)
RATING SCALE Definitions Past Performance Evaluation Ratings Rating Description
Acceptable (A) Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)
Unacceptable (U) Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.
The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.
QUALITY OF SERVICE
1. Rate the contractor’s compliance with contractual requirements.
A U
2. Overall rating of contractor quality of service.
A U
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
SCHEDULE
1. Delivery of service was within required time period specified by contract requirements.
A
U
2. Rate the contractor’s ability to control cost and submit invoices.
Are invoices complete, accurate, and timely? A U PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
BUSINESS RELATIONS
Overall rating of contractor’s business practices (e.g. maintaining A positive working relationship, business ethics, timely and effectively
| Resolution of any problems, etc.) | A | U |
| Rate the working relationship between contractor’s management, and your company (i.e. contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern |
| for the interest of the customer). | A | U |
| Rate the contractor's ability to submit required reports |
and/or invoices in a timely manner. A U
Rate the contractors responsiveness to customer
| complaint resolution. | A | U | |
| Overall rating of contractor’s business relations. | A | U PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING: |
How would you feel about awarding another contract to this contractor?
| Would not hesitate to award another contract to this contractor. |
| Would most likely award another contract to this contractor. |
| Would think twice about awarding another contract to this contractor, but would do so if no better alternative existed. |
| Do not wish to award another contract to this contractor. |
| Would not award another contract to this contractor. |
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.
Acceptable Unacceptable
VII. General Comments:
ASSESSOR: Identify your role in the contract award or administration and the period of your involvement.
Role Period of Involvement
Contract Specialist/Contracting Officer
Technical Project Lead/Project Officer
OTHERS
(Signature) (Date)
(Typed or Printed Name) (Organization Name)
(Phone Number) (Organization)
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| PWS UPDATED PWS.docx | DOCX document | |
| Questions for Clarksburg-Ken.Anthony Comments 9.12.25.docx | DOCX document | |
| 36C24525R0098.pdf | ||
| 36C24525R0098_1.docx | DOCX document |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
File details come from the government source that posted it. Updated .