36C24820Q0208-004.docx

PAST PERFORMANCE QUESTIONNAIRE

Name of offeror: ___________________________________

Contract Information:

Name of Contractor: _________________________________ Contract Number: ___________________________

Contract Title: ________________________________________________________________________________

Type of Contract: ____________________________________ Period of Performance: ______________________

The ratings indicated below are to be supplied by the reference and not the offeror)

1. Technical (Quality of Product or Service) (evaluation of the contractor’s technical performance or progress toward meeting requirements)

2. Schedule (evaluation of the timeliness of the contractor against milestones, delivery schedules)

3. Cost Control (evaluation of the contractor’s effectiveness in forecasting, managing, controlling cost and submitting accurate invoices)

4. Business Relations (assess the integration and coordination of all activity needed to execute the work, specifically the timeliness, completeness and quality of problem identification, corrective action, the contractor’s history of reasonable and cooperative behavior, customer satisfaction)

5. Management of Key Personnel (assess the contractor’s personnel performing the work)

6. Overall Rating

Remarks on unsatisfactory performance (Provide data supporting this observation. You may continue on separate sheet if needed.)

Would you do business with the offeror again? ________________________________________________________

Information provided by:

Name of Source: ___________________________________________________ Title: ____________________________________________________________ Mailing Address: ___________________________________________________ City, State and Zip Code: ____________________________________________ Telephone Number: ________________________________________________ Date: ____________________________________________________________

Questionnaire completed by:

Name of VA Employee: ____________________________________________ Title: ___________________________________________________________ Date: ___________________________________________________________ Signature: _______________________________________________________