36C25018Q9284-006.docx
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- Solicitation number
- 36C25018Q9284
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36C25018Q9284 Attachment 5-PAST PERFORMANCE QUESTIONNAIRE FOR Rad-Onc VANIHCS.docx
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| File | Type | Posted |
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| 36C25019D0035-000.docx | DOCX document | |
| 36C25018Q9284-0001000.docx | DOCX document | |
| 36C25018Q9284-003.pdf | ||
| 36C25018Q9284-001.docx | DOCX document | |
| 36C25018Q9284-005.pdf | ||
| 36C25018Q9284-007.pdf | ||
| 36C25018Q9284-002.pdf | ||
| 36C25018Q9284-004.pdf | ||
| 36C25018Q9284-000.docx | DOCX document |
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PAST PERFORMANCE QUESTIONNAIRE
REQUEST FOR QUOTATION (RFQ) 36C25018Q9284
COMMUNITY NURSING HOME SERVICE FOR
VA Northern Indiana Healthcare System (VANIHCS)
MESSAGE TO THE EVALUATOR: Your assistance is requested by Michelle C. Ford, Contracting Specialist to assist with establishing the performance history for the Company (Quoter) named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to: michelle.ford2@va.gov. If enough space is not provided, then please attach additional information to this questionnaire. Please provide the survey back on or before the date and time specified in Block 8 of the SF1449.
1. Name of Quoter submitting Quote:
Contract Number with your organization:
Title/Description of Contract:
Period of Performance:
Based upon the definitions below, indicate your assessment of the Quoter’s performance. Your assessment should consider the Quoter’s performance in accordance with the contractual requirements. Please include the period of performance and contract value:
2. Brief description of scope of work:
EVALUATION: Please rate the Quoter using the guide and the pull-down menus in the evaluation table below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.
| ASSESSMENT |
| DEFINITION |
| Outstanding (O) |
| The Quoter’s performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Quoter were highly effective. |
| Above Average (A) |
| The Quoter’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Quoter were effective. |
| Satisfactory (S) |
| The Quoter’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Quoter were satisfactory. |
| Unacceptable (U) |
| Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the Quoter has yet to identify corrective actions or the Quoter’s proposed actions appear only marginally effective or were not fully implemented. |
| Completed scheduled services in a timely manner per the Performance Work Statement (PWS). |
| Choose an item. |
| Compliance with contractual Terms and Conditions. |
| Choose an item. |
| Provided experienced physician with sufficient technical and administrative abilities needed to meet contract requirements. |
| Choose an item. |
| Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period. |
| Choose an item. |
| Provided effective quality control and/or inspection procedures to meet contract requirements. |
| Choose an item. |
| Corrected deficiencies in timely manner and pursuant to the Quoter’s quality control procedures. |
| Choose an item. |
| Exhibited knowledge of and compliance with Government (or other) regulations and industry standards. |
| Choose an item. |
| Effectively responded to urgent requests in a timely manner per the Performance Work Statement (PWS). |
| Choose an item. |
| Solved contract performance problems without extensive guidance from procurement or technical personnel. |
| Choose an item. |
| Provided timely and accurate documents, records, and invoices as required by the contract. |
| Choose an item. |
| Rate the Quoter’s OVERALL quality of performance under this contract |
| Choose an item. |
Would you award similar contracts to this Quoter? Please provide explanation for response.
EXPLANATION OF OVERALL RATING GIVEN:
ADDITIONAL COMMENTS (use additional pages as required)
ASSESSOR NAME AND INFORMATION
Name & Signature of Assessor’s:
Company/Agency: Date:
Position Title/Grade: Contracting Officer Phone:
Email: Fax:
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