Attachment 5 - Past Performance Questionnaire_2.pdf
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- Solicitation number
- 36C24826R0062
About this file
This is a Past Performance Questionnaire for Request for Quote 36C24826R0062, issued by the James A. Haley Veterans Hospital (JAHVH) for Emergency Residential Services. The questionnaire is a template designed to be completed by references identified by vendors to validate their past performance on similar contracts or agreements. Responses must be returned to Peter Bedard at peter.bedard@va.gov by a date specified by the contractor.
The questionnaire uses a five-point rating scale (Outstanding, Above Average, Satisfactory, Marginal, and Unacceptable) to evaluate vendor performance across four customer satisfaction criteria: maintenance of a professional staff, responsiveness to inquiries regarding contract/agreement, flexibility in responding to urgent requirements, and overall customer satisfaction. Respondents must provide brief narrative explanations for any Marginal or Unacceptable ratings, or indicate N/A if performance information is unavailable. The form concludes with a yes/no question regarding whether the evaluator would hire the company again, requests an overall rating, and requires the evaluator's contact information including name, title/grade, email, phone number, company/city, and date completed. Handwritten responses in ink are acceptable, and additional sheets may be attached if more space is needed for comments.
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Attachment. D.5
PAST PERFORMANCE QUESTIONNAIRE
Request for Quote - 36C24826R0062
Emergency Residential Services
1. Background: The James A. Haley Veterans Hospital (JAHVH) has an ongoing requirement for Emergency Residential Services. The vendor has identified you as a reference to validate the their past performance.
This question is concerns pass or current contractors/agreements for which you have personal knowledge.
2. Instruction: Please complete this questionnaire based on the following guidance. Please take the time to answer the questions to the best of your knowledge. Circle the responses that best describe the company’s performance and write in a narrative explanation for you answer. Use a N/A rating to indicate that you have no performance information for that particular area, or if the question does not apply to you. Each question has space for your comments. If more space is needed, please attach additional sheets to the end of the questionnaire and reference to respective questions. Handwritten (ink) responses are sufficient.
Please complete the following questionnaire to assist our evaluation of the company's past performance and return no later than the date the contractor advises. Please return to Peter Bedard email at peter.bedard@va.gov .
Name of Company: _____________________________________________
Title/Description of Proposed Project:
Please evaluate the past performance using only the following ratings without variation. If the ratings is Marginal or Unsatisfactory, please provide additional information in the appropriate block or in the remarks section of this form
“O” = Outstanding = Performance greatly exceeded the contract requirements “A” = Above Average = Performance exceeded the contract requirements “S” = Satisfactory = Performance met the contract requirements “M = Marginal = Performance meet the minimum contract requirements but some material aspects of the company's performance were less than satisfactory “U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements mailto:osetta.quinn@va.gov
CUSTOMER SATISFACTION
1. Company maintain a professional staff.
Outstanding Above Average Satisfactory Marginal Unacceptable
BRIEF EXPLANATION OF RATING GIVEN:
2. Company was responsive to inquiries regarding contract/agreement.
Outstanding Above Average Satisfactory Marginal Unacceptable
BRIEF EXPLANATION OF RATING GIVEN:
3. Company was flexible in responding to urgent requirements.
Outstanding Above Average Satisfactory Marginal Unacceptable
BRIEF EXPLANATION OF RATING GIVEN:
4. Overall customer satisfaction.
Outstanding Above Average Satisfactory Marginal Unacceptable
BRIEF EXPLANATION OF RATING GIVEN:
Outstanding Above Average Satisfactory Marginal Unacceptable
5. Would you hire this company again?
If yes, explain in “comments.” Yes/No
Comments:
Overall Rating: ____________________________________
Name of Evaluator: ______________________________ E-Mail: ______________________________
Position Title/Grade: _____________________________ Phone Number: _______________________
Company/City: _____________________ Date Questionnaire Completed: ______________________
File details come from the government source that posted it. Updated .