36C24619Q0644-004.docx
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- Elevator Safety Test (No Load and Full Load)
- Solicitation number
- 36C24619Q0644
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36C24619Q0644 Past Performance Survey.docx
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D.3 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. 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 May 16, 2019, by email to: crystal.carter5@va.gov. |
Thank you for your time and participation.
PAST PERFORMANCE SURVEY
36C24619Q0413, ELEVATOR LOAD SAFETY TESTS – CHARLES GEORGE VAMC
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
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: Crystal Carter |
E-MAIL: crystal.carter5@va.gov
Deadline: No Later Than 05/16/2019
| 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
SOURCE SELECTION INFORMATION
SEE FAR 3.104
FOR OFFICIAL USE ONLY
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