36C24620Q0089-0002002.pdf

PAST PERFORMANCE SURVEY INSTRUCTIONS

The Department of Veterans Affairs Network Contracting Office 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 paul.waite@va.gov or FAX your response to 757-728-3132 no later than 9 December , 2019.

Thank you for your time and participation.

mailto:paul.waite@va.gov

PAST PERFORMANCE SURVEY

REPAIRS, MAINTENANCE AND INSPECTION ON ALL DOORS CRITICAL LIST

AT DURHAM VA MEDICAL CENTER

36C24619Q1124

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:

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.

11. Provided timely resolution of contract discrepancies.

Comments:

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

TO: Paul Waite

E-MAIL: paul.waite@va.gov

FAX: (757) 315-3969

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 mailto:paul.waite@va.gov

NA No Knowledge of This Element

Deadline: No Later Than 04:30PM EST, 12/9/2019

SOURCE SELECTION INFORMATION

SEE FAR 3.104

FOR OFFICIAL USE ONLY