36C24618Q9673-002.pdf

PAST PERFORMANCE SURVEY

PAST PERFORMANCE SURVEY INSTRUCTIONS

The Department of Veterans Affairs Mid-Atlantic Healthcare Network, VISN 6 is considering the Offeror for award of a VA contract for administrative, logistical, and coordination services for the planning, development, and production of high quality educational offerings. Your comments would be appreciated regarding this firm’s past performance. The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s).

a. Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone and fax number.

b. Include the contractor’s name and address, the title and/or description of the type of work performed the award number, the value of the contract (including options), the award and completion date of the project and the type of award/solicitation.

c. Use the rating scale found on the bottom left corner of the questionnaire to rate each performance element.

d. Comments are encouraged and would be appreciated. Clear handwritten responses are sufficient.

e. Please e-mail your response no later than 4:00PM EST on August 27, 2018, by email to:

Cherisse.Hall@va.gov.

Thank you for your time and participation.

mailto:Cherisse.Hall@va.gov

PAST PERFORMANCE SURVEY

YOUR NAME & TITLE

YOUR ORGANIZATIONAL ADDRESS

TEL NO.

FAX :

E-MAIL:

CONTRACTOR’S NAME & ADDRESS

TITLE OR DESCRIPTION OF REQUIREMENT:

CONTRACT NUMBER:

CONTRACT VALUE (INCLUDING OPTIONS):

CONTRACT TYPE (circle one):

FIXED PRICE COST + FEE

COMPETITIVE NON-COMPETITIVE

SET-ASIDE

SEALED BID NEGOTIATED

CONTRACT AWARD & COMPLETION DATE:

PAST PERFORMANCE ELEMENT

RATING

1 2 3 4 5 6 NA

1. Contractor demonstrated a thorough understanding of technical requirements of the contract/task.

Comments:

2. Contractor anticipated/identified and resolved problems effectively.

Comments:

3. Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.

Comments:

4. Contractor provided the necessary skilled personnel to perform the required work.

Comments:

5. Contractor retained the necessary skilled personnel and maintained a low turnover rate.

Comments:

6. Contractor met scheduled contract delivery dates.

Comments:

7. Contractor provided accurate, complete and high quality deliverables.

Comments:

8. Contractor complied with the terms of the contract.

Comments:

9. Contractor was diligent in forecasting and controlling contract cost.

Comments:

10. I would recommend award to this contractor again.

Comments:

1 0 – 25% of the time Strongly Disagree PLEASE RETURN COMPLETED RESPONSE

TO: Cherisse Hall E-MAIL: Cherisse.Hall@va.gov

VA Mental Health and Chaplaincy

2 26 – 40% of the time Disagree 3 41 – 55% of the time Somewhat Disagree 4 56 – 70% of the time Somewhat Agree 5 71 – 85% of the time Agree 6 86 – 100% of the time Strongly Agree

NA No Knowledge of This Element mailto:Cherisse.Hall@va.gov

PAST PERFORMANCE SURVEY