36C24718R0541-034.pdf

ATTACHMENT 5

PAST PERFORMANCE QUESTIONNAIRE

RFP NUMBER: 36247-18-R-0541

TITLE: Upgrade Elevator Systems OFFER / QUESTIONNAIRE DUE DATE: With Proposal

SECTION I: OFFERORS: COMPLETE requested information (Section I) and PROVIDE the questionnaire to the appropriate Respondent for each source of Past Performance Information mentioned in your Offer. The Respondent must have significant familiarity with the selected contract or subcontract in order to provide informed answers and comments about various aspects of the past performance.

SECTION II: RESPONDENT(S): COMPLETE the requested information (Section II) concerning the past performance of the above-named Offeror relative to the referenced contract effort.

QUALITY OF SERVICE

1. Did the contractor comply with all contract requirements? Yes No Comments:

2. With regard to timeliness of performance, were turnaround times of the contract met (i.e.

completion of administrative requirements, task orders, milestones, production and delivery requirements?) Yes No

3. Was the contractor's work found to be accurate and technically/clinically sound?

NAME OF OFFEROR

NAME OF PAST PERFORMANCE SOURCE

CONTRACT NUMBER and DATES OF SERVICE

DESCRIPTION OF SERVICE

TOTAL AWARDED PRICE

NAME OF RESPONDENT

TITLE/POSITION

SIGNATURE

Yes No

4. How would you rate the quality of the contractor's end products / services furnished under this contract?

Outstanding Good Acceptable Unacceptable

5. How would you rate the quality of the contractor's customer service furnished under this contract?

BUSINESS RELATIONS

6. Was contract Management efficient and responsive?

Always Most of the time Sometimes Never

7. Did the contractor exhibit effective communication(s)?

8. Did the contractor exhibit reasonable and cooperative behavior?

Always Most of the time Sometimes Never

9. Was the contractor flexible?

Always Most of the time Sometimes Never

10. Did the contractor recommend effective solutions to problems?

Always Most of the time Sometimes Never

11. Did the contractor exhibit a business-like concern for the interests of your Agency or Business:

12. How would you rate the contractor in the area of business relations generally?

Comments on questions 6 through 11 above:

CUSTOMER SATISFACTION

13. How would you rate the contractor on the basis of customer (end-user) satisfaction?

14. Would you select this firm again?

Yes No

End of Section II

POC: April Brooks

Contract Specialist april.brooks1@va.gov

SECTION III: COMPLETED FORM MUST BE RETURNED TO THE VA

CONTRACTING OFFICE PRIOR TO THE DUE DATE FOR RECEIPT OF

PROPOSALS. THE OFFEROR MAY SUBMIT THE COMPLETED QUESTIONNAIRE

ALONG WITH HIS/HER PROPOSAL; OR, THE RESPONDENT PROVIDING THE

PERFORMANCE INFORMATION HEREIN MAY FORWARD THE COMPLETED FORM

DIRECTLY TO THE CONTRACTING OFFICE, IF PREFERRED.

IN ALL CASES, THE COMPLETED PAST PERFORMANCE REFERENCES MUST REACH

THE CONTRACTING OFFICE BY THE DATE AND TIME OFFERS ARE DUE. THE

GOVERNMENT BEARS NO RESPONSIBILITY TO ASSURE QUESTIONNAIRES ARE

PROPERLY RECEIVED.