36C24619Q0279-002.docx

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. 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 to lori.miller@va.gov or FAX your response to 757-728-3132 no later than April 8, 2019.

Thank you for your time and participation.

PAST PERFORMANCE SURVEY

DURHAM VAMC SHREDDING & RECYCLING SERVICES

36C24619Q0279

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):

FIRM FIXED PRICE COST + FEE

COMPETITIVE NON-COMPETITIVE

SET-ASIDE

SEALED BID NEGOTIATED

SEALED BID NEGOTIATED

CONTRACT AWARD & COMPLETION DATE:

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:

E-MAIL: lori.miller@va.gov

FAX: (757) 728-3132

Deadline: No Later Than 04/08/2019

NA

No Knowledge of This Element

SOURCE SELECTION INFORMATION

SEE FAR 3.104

FOR OFFICIAL USE ONLY