36C24920R0020-061.pdf

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104

Project # 626A4-18-105 - Renovate Ward 1A Solicitation # 36C24920R0020

ATTACHMENT - A

PAST PERFORMANCE QUESTIONNAIRE

1. TRANSMITTAL LETTER SAMPLE

<Your Company Letterhead>

Date: ___________________

To:

We have listed your firm as a reference for the work we have performed for you as listed below.

Our firm has submitted a proposal under a project advertised by Network Contracting Office 09

(NCO 09), located at 1639 Medical Center Parkway, STE 400, Murfreesboro, Tennessee, 37129.

In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance, and you our candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible.

Understand that while the responses to this questionnaire may be released to the offeror, FAR

15.306 (e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address (or to the company that sent this, per their instructions.)

Department of Veterans Affairs

Network Contracting Office 09 (NCO 09)

Attn: Shawn Hendricks or via email to: shawn.hendricks@va.gov

1639 Medical Center Parkway

Murfreesboro, TN 37129

If you have questions regarding the attached questionnaire, or require assistance, please contact

Shawn Hendricks at (615) 225-6409.

Thank you for your assistance.

Please be advised that “E-Mail” is the preferred method of receiving the requested information.

<Signature and Title of Principal> mailto:shawn.hendricks@va.gov mailto:shawn.hendricks@va.gov

Project # 626A4-18-105 - Renovate Ward 1A Solicitation # 36C24920R0020

2. GENERAL INFORMATION: (Contractor to be evaluated)

Name of Contractor:

Point of Contact: Title: E-mail:

Address of Record: Office Phone: Fax:

Contract#: Dollar Amount:

Dates of Performance:

Contractor Performed as: Prime Contractor Sub-Contractor

Project Title and Brief Description of Work:

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

3. RESPONDENT INFORMATION: (Government Official)

Name of Respondent: Title: E-mail:

Address of Record: Office Phone: Fax:

4. TRANSMITTAL INSTRUCTIONS: E-mail completed survey to Douglas Crowley, Network Contracting Office 09 (NCO 09) at douglas.crowley@va.gov mailto:matthew.whisman@va.gov mailto:matthew.whisman@va.gov

Project # 626A4-18-105 - Renovate Ward 1A Solicitation # 36C24920R0020

5. PERFORMANCE INFORMATION: Choose the appropriate adjectival rating that most accurately describes the contractor’s performance.

Exceptional Performance exceeded most of the contractual requirements to the government’s/client’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor exceeded expectations.

Good Performance exceeded some of the contractual requirements to the government’s/client’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were effective and timely.

Satisfactory Performance met contractual requirements. The contractual performance of the element or sub-element being assess was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal Performance did not meet some contractual requirements. The contractual performance of the element or sub-elements 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.

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

Neutral/ Not

Applicable or

Unknown

No performance record identifiable within the area of evaluation.

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

Quality of technical data/report preparation efforts E G S M U N

Ability to meet quality standards specified for technical performance E G S M U N

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

E G S M U N

Project # 626A4-18-105 - Renovate Ward 1A Solicitation # 36C24920R0020

Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

(without adverse effect on performance)

E G S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

Compliance with contract delivery/completion schedules including any significant intermediate milestones E G S M U N

Rate the contractor’s use of available resources to accomplish tasks identified in the contract E G S M U N

3. CUSTOMER SATISFACTION:

To what extent were the end users satisfied with the project? E G S M U N

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E G S M U N

To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

E G S M U N

Overall customer satisfaction E G S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

E G S M U N

Government/client Property Control E G S M U N

Knowledge/expertise demonstrated by contractor personnel E G S M U N

Ability to simultaneously manage multiple projects with multiple disciplines E G S M U N

Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to

Government/client changes

E G S M U N

Effectiveness of overall management (including ability to effectively lead, manage and control the program)

E G S M U N

5. COST/FINANCIAL MANAGEMENT

Ability to meet the terms and conditions within the contractually agreed price(s)?

E G S M U N

Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the Government/client

E G S M U N

Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes No

6. SAFETY/SECURITY

Project # 626A4-18-105 - Renovate Ward 1A Solicitation # 36C24920R0020

To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E G S M U N

Contractor complied with all security requirements for the project and personnel security requirements.

E G S M U N

7. GENERAL

Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting

Officer in a timely manner regarding urgent contractual issues).

E G S M U N

Compliance with contractual terms/provisions (explain if specific issues) E G S M U N

Would you hire or work with this firm again? (If no, please explain below)

Yes No

In summary, provide an overall rating for the work performed by this contractor.

E G S M U N

Please provide frank responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (attach additional pages if necessary):