36C24819Q0403-002.pdf

Past Performance Questionnaire Instructions

The “offeror” (identified in Section I, Block A) is submitting a response to a solicitation issued by the Department of Veterans Affairs, Veterans Integrated Service Network (VISN) 8, for Boiler Safety Device Testing, Program Development and Training services to be performed at facilities located in Bay Pines FL and Lee County, Miami FL, Gainesville FL, Lake City FL, Orlando FL (Lake Nona and Lake Baldwin), San Juan PR, Tampa FL, and West Palm Beach FL.

Your candid responses to this questionnaire will assist VISN 8 in evaluating the offeror’s past performance (i.e. How was the quality of the services this offeror provided in the past?). By gathering this information (not only on this offeror, but on all the companies who submit an offer to provide these required services) we strive to determine which company’s offer will be most advantageous to VA.

PLEASE EMAIL COMPLETED Questionnaires NLT 12 APRIL 2019 @ 4:00 PM EST to: Keila President EMAIL: keila.president@va.gov

Should you have any questions regarding this questionnaire, please feel free to contact the above contract specialist at (813)978-5998 or email keila.president@va.gov .

Section I - Details of Company Being Evaluated

A. Offeror’s Information:

1. Company

2. Address:

3. Company POC’s Name:

4. POC’s Title:

5. POC’s Phone #:

6. POC’s Email:

7. Identify Prime contractor or SUB contractor:

B. Information regarding Past Contract(s*) being evaluated: *(attach additional pages if necessary)

1. Contract #:

2. Customer (Firm Name):

3. Performance Period when work was done

4. Location(s) of Work Performed:

5. Scope of Contract (i.e. Brief Description of Work Performed).:

6. Average Annual $ amount:

7. Awards or Incentives (if applicable)

SECTION II - Details of Evaluator (Person providing Evaluation of Offeror)

1. Evaluator’s Name:

2. Title:

3. Organization:

4. Evaluator’s Phone #:

5. Evaluator’s Fax #:

6. Evaluator’s Email:

mailto:keila.president@va.gov

SECTION III - Customer Satisfaction/Quality of Service Questions (To be Filled Out only by the “Evaluator”)

PERFORMANCE LEVEL- Rating/definitions

OUTSTANDING- Performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

SATISFACTORY- Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

NEUTRAL- Past Performance was never obtained or completed to determine if it meets contractual requirements.

MARGINAL- Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

FAIL- Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

KEY: O=OUTSTANDING S=SATISFACTORY N=NEUTRAL M=MARGINAL F=FAIL

1. How satisfied are you with the overall performance this offeror provided?

O S N M F

2. To what degree did this offeror conform to your contract’s requirements?

O S N M F

3. How effective was this offeror in establishing and maintaining a positive working relationship?

O S N M F

4. Were any awards or incentives given for outstanding or excellent performance?

Yes No

5. To what extent did the contractor respond to and attempt to correct any concerns, issues, or problems that appeared during performance of your contract?

O S N M F

6. What extent was this offeror flexible in responding to changing needs? O S N M F

7. How would you rate the effectiveness of the contractor’s problem resolution efforts?

O S N M F

8. Did this offeror submit complete and accurate invoices for payment of services provided? If not, was the offeror willing to correct them?

Yes No

9. Did this offeror generally meet performance schedule? O S N M F

10. To what degree did this offeror provide the right personnel and number of personnel to complete your requirement in a timely manner?

O S N M F

11. To what degree did this offeror provide the right types and quantities of supplies to complete your requirement in a timely manner?

O S N M F

12. To what degree did this offeror provide the right types and quantities of equipment to complete your requirement in a timely manner?

O S N M F

13. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain below.

Yes No

14. If given an opportunity, would you conduct business with this offeror again?

Yes No

Section IV: Closing Comments

1. Provide any additional comments you feel would be pertinent regarding past performance of this company:

PLEASE EMAIL COMPLETED QUESTIONNAIRES to: keila.president@va.gov NLT 12 April 2019 @ 4:00 P.M. EST.

mailto:keila.president@va.gov