Attachment 3. Past Perfomance Questionnaire.pdf

This is a Past Performance Questionnaire template used by the Veterans Healthcare Administration (VHA) to evaluate contractor performance for award decisions. The form requires completion by firms or agencies that have previously worked with the contractor being evaluated, and responses must be submitted directly to Scott Dickey at scott.dickey@va.gov by August 19, 2025 at 11:00am CST.

The questionnaire collects basic contract information including contractor name, period of performance, award date, completion date, contract type, awarded value, and current dollar value. It requires the assessing official to provide their contact information and relationship to the firm being rated. The core evaluation covers eight performance categories rated on a six-point scale from Unsatisfactory to Exceptional: Quality of Product or Service, Schedule, Cost Control, Business Relations, Management of Key Personnel, Reliability, Customer Support, and Overall Performance. The form also includes space for two additional assessment areas and written comments, with instructions emphasizing that responses should not be sent to the contractor requesting the evaluation.