36C24819Q0309-002.docx

3624819Q0309

PAST PERFORMANCE QUESTIONAIRE

Past Performance Questionnaire VHA Service Area Office East Network Contracting Office 8 13800 Veteran’s Way Orlando, FL 32827

(TO BE COMPLETED BY OFFEROR)

Contract/Project/Task Order Information. Complete the general contract information below.

Name of Firm/Contractor:

Contract/Task Order Number:

Contract Type:

Project Title/Description of Work:

Value/Dollar Amount of Contract:

Performance Period:

Type of Labor Used:

Completion Date(s)

(TO BE COMPLETED BY CONTRACTOR’S REFERENCE)

A. Respondent/Agency Information Firm/Agency Installation:

Name of Respondent:

Title:

Phone No. Email:

B. Past Performance Survey: For the purposes of this survey the government will receive an overall assessment of what the contractor can perform in accordance with the solicitation, using the ratings below. In responding to the survey, please justify and explain exceptional, marginal, and unsatisfactory ratings. Please include comments to explain all ratings given. Respondent may be contacted to clarify comments or ratings. In order for the government to review and assess the contractor's past performance rating, please use the following ratings to describe the offeror's performance on your contract or project:

Outstanding Performance met and exceeded all contract requirements. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

Very Good Performance met all contract requirements and exceeded some or most. There were a few minor problems that the contractor resolved in a timely, effective manner.

Satisfactory Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

Marginal Performance did not meet some contractual requirements. There were problems, some of a significant nature, for which corrective action was only marginally effective.

Unsatisfactory Performance did not meet most contractual requirements. There were serious problems and the contractor's corrective actions were ineffective.

Unknown No record of past performance or the record is inconclusive.

NOTE: If you have rated this contractor on this particular contract or project in CPARS or some other evaluation system accessible to the Government, you may indicate that past performance information on this contract/project is available in the appropriate system and you may include a copy of that rating in lieu of the following questionnaire.

Management Effectiveness

1. Overall performance of the management team.

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

2. Contractor provided competent program/project manager, supervisors, and workers.- Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

3. Contractor protected any leased or other property provided through the contract (i.e. buildings, computers, equipment, etc.)

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

4. Contractor managed documentation (i.e. planning documents, instructions, policies, training, licensing, certificates, etc.)

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

Quality Control

5. Provided effective Quality Control which resulted in acceptable services (i.e. few or no unsatisfactory; timeliness of delivery).

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

6. The contractor's quality control system established adequate procedures to find and correct performance discrepancies.

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

7. Contractor adherence to the quality control plan. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

8. Contractor worked closely with your company's/agency's quality control personnel. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

Timeliness/Adherence to Schedules

9. Contractor managed scheduling and deadlines of the contract (i.e. reports due, meeting attendance, delivery of services, etc.)

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

10. Contractor responded to emergency/surge requirements in a timely manner. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

Customer Satisfaction

11. Contractor maintained a professional working relationship. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

12. Contractor was reasonable and cooperative in resolving customer complaints. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

13. Contractor was flexible in responding to customer requirements.

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

14. Overall customer satisfaction. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

15. Program/project manager had the authority to carry out the day-to-day operations of the contract/project.

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

Safety and Labor

16. Contractor complied with applicable labor laws. Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

General Questions

17. Would your organization award another contract to this contractor? (Circle one) YES or NO

Please provide explanation.

18. The overall rating the contractor would be given for this project.

Outstanding Very Good Satisfactory Marginal Unsatisfactory Unknown

NARRATIVE:

Additional Comments:

C. You are advised that the FAR requires that the offeror be given an opportunity to respond to adverse past performance information.

D. Thank you for your time and effort in assisting us with our requirement.