PAST PERFORMANCE QUESTIONNAIRE.pdf

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information (See FAR 2.101 & 3.104)

ATTACHMENT 2 - PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO CONTRACTOR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contact(s), asking them to please complete the form and submit it per the instructions, below.

INSTRUCTIONS TO RESPONDENT

The contractor named below is submitting an offer for a U.S. Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact. Please complete this form in full (all areas shaded in light yellow, below).

Once completed, please return to the Contractor so they may submit this form with their proposal.

If you have any questions, please contact Angie Carpenter via email at angie.carpenter@va.gov. Thank you for your assistance in this matter.

CONTRACTOR INFORMATION [completed by Contractor]

Contractor Company Name Contractor Street

Address

Contractor Point of Contact Name Phone Number

Reference Project Title Contract Number

(Include Order #)

Awarded Period of Performance (Dates)

Final Period of Performance (Dates)

Awarded Value $ Final Value $

Number of Modifications Contractor Email

Address

Description of Work

Role of Contractor on This Project (check appropriate box)

☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel mailto:angie.carpenter@va.gov

RESPONDENT INFORMATION [completed by respondent]

Name

Street Address

Phone Number

City

Email Address

State

Agency/Firm

Zip Code

PERFORMANCE INFORMATION: On the scale choose the number 1 to 5 or N/A that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A SUPPORTING NARRATIVE FOR ANY RATINGS OF 1 OR 2 in the Remarks section, below (text box will expand to whatever extent is necessary).

1 2 3 4 5 N/A

UNSATISFACTORY MARGINAL SATISFACTORY GOOD EXCEPTIONAL NOT

APPLICABLE

Indicates one or more deficiencies that creates the risk that the offeror will not be able to successfully perform the contract.

Noted strengths are not sufficient to offset noted weaknesses.

Risk of unsuccessful performance is high.

Noted weaknesses noted are generally offset by noted strengths or are of such a nature that they are not expected to seriously affect the offeror’s performance. Risk of unsuccessful performance is moderate.

Noted strengths generally outweigh any weaknesses noted. Risk of unsuccessful performance is low.

Noted strengths significantly outweigh any weaknesses noted.

Risk of unsuccessful performance is very low.

The Contractor… 1 2 3 4 5 N/A

1.

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3.

Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Home office participated in solving significant local problems. ☐ ☐ ☐ ☐ ☐ ☐

5. Followed approved quality control plan. ☐ ☐ ☐ ☐ ☐ ☐

6. Provided effective quality control and/or inspection procedures to meet contract requirements. ☐ ☐ ☐ ☐ ☐ ☐

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures. ☐ ☐ ☐ ☐ ☐ ☐

8. Provided timely resolution of contract discrepancies ☐ ☐ ☐ ☐ ☐ ☐

9. Identified problems as they occurred. ☐ ☐ ☐ ☐ ☐ ☐

10. Suggested alternative approaches to problems. ☐ ☐ ☐ ☐ ☐ ☐

11. Displayed initiative to solve problems. ☐ ☐ ☐ ☐ ☐ ☐

12. Developed realistic progress schedules. ☐ ☐ ☐ ☐ ☐ ☐

13. Met established project schedules. ☐ ☐ ☐ ☐ ☐ ☐

14. Provided timely resolution of warranty defects. ☐ ☐ ☐ ☐ ☐ ☐

15. Was responsive to contract changes. ☐ ☐ ☐ ☐ ☐ ☐

16. Provided adequate project supervision. ☐ ☐ ☐ ☐ ☐ ☐

17. Obtained consent of surety for increases in bonding as work-in-progress increased. ☐ ☐ ☐ ☐ ☐ ☐

18. Paid subcontractors/suppliers in a timely manner. ☐ ☐ ☐ ☐ ☐ ☐

19.

Provided accurate and complete line item cost proposals including all aspects of work required for each task.

20. Ensured the health and safety of all personnel during the execution of work ☐ ☐ ☐ ☐ ☐ ☐

21. Followed all regulatory requirements ☐ ☐ ☐ ☐ ☐ ☐

22. Cooperated with Government personnel after award. ☐ ☐ ☐ ☐ ☐ ☐

23. How would you rate the contractor's overall performance? ☐ ☐ ☐ ☐ ☐ ☐

24.

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

Choose an item.

25. Would you award another contract to this contractor? If not, please explain in “remarks.” Choose an item.

26. To the best of your knowledge, is the contractor rated in CPARS? Choose an item.

REMARKS (Please use as much space as is needed – the box will expand as you type).

ATTACHMENT 2 - PAST AND PRESENT PERFORMANCE QUESTIONNAIRE