Exhibit O - Past Performance Questionnaire.pdf

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X1DB--Additional Files - West Branch 36C25024R0209
Solicitation number
36C25024R0209
Issued by

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This is a Past Performance Questionnaire template used by the Department of Veterans Affairs (VA) to evaluate contractor performance on federal contracts and projects. The form is specifically designed for RLP No. 36C25024R0209 related to the West Branch VA Clinic project.

The questionnaire collects comprehensive information about the firm being rated, including the firm name, primary contact, contracting agency, project details, contract type, award date, completion date, awarded value, and current contract dollar value. The assessing official must provide their name, email, phone number, and describe their association with the rated firm. The evaluation section requires assessment across nine performance categories: compliance with lease requirements, quality of services, timely delivery of services, business relations, management of key personnel, reliability, customer support, overall performance, and two additional areas as needed. Each category is rated on a five-point scale (Unsatisfactory, Marginal, Satisfactory, Very Good, Exceptional) or marked as Not Applicable. The form includes space for additional comments and requires completion by the reference with signature, title, and date. References must submit completed questionnaires directly to the VA's Contract Officer at Lisa.Newlin@va.gov no later than 12:00 PM Local Time on 04/15/2025, with a subject line identifying the RLP number and offeror name. The Government reserves the right to verify all information provided.

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West Branch VA Provided Schematic.zip ZIP file
RLP 36C25024R0209-Excel Files.zip ZIP file
36C25024R0209 0002_2.docx DOCX document
36C25024R0209 0002_1.docx DOCX document
36C25024R0209 - West Branch-RLP R100_AMD0002_May_2026.pdf PDF
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Exhibit B1 Room Design Matrix Section 9.xlsx XLSX spreadsheet
Exhibit I Tenant Improvements Cost Summary TICS Table.xlsx XLSX spreadsheet
36C25024R0209_2.docx DOCX document
Exhibit P - Appendix - Applicable Codes and Standards.pdf PDF
Exhibit L - Offering Entity Acknowledgement Form.pdf PDF
Exhibit G - 1217 Lessor Annual Cost Statement.pdf PDF
Exhibit F - 1364 Proposal to Lease Space.pdf PDF
36C25024R0209_1.docx DOCX document
Exhibit E - GSA Form 3517B General Clauses_Mar_2026.pdf PDF
36C25024R0209 - West Branch-RLP R100_May_2026.pdf PDF
Exhibit N - Pre-Proposal Conference Registration.pdf PDF
Exhibit M - Contractor Confidentiality Certificate.pdf PDF
Exhibit H - GSA Form 12000 Prelease FPLS Eval Off Bldg rev.5.2015.pdf PDF
Exhibit K - DOL Wage Determination WD MI20260143_1.02.2026.pdf PDF
Exhibit J - VA6500.6 Contractor Security IT Handbook.pdf PDF
Exhibit D - GSA Form 3516 Solicitation Provisions_Mar_2026.pdf PDF
Exhibit C - FSL Level II - VA Security Requirements and Price_Oct_2024.pdf PDF
Exhibit B - Agencys Specific Requirements_ASR.pdf PDF
Exhibit A - 36C25025L0014 - West Branch Lease L100_May_2026.pdf PDF
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1. NAME OF FIRM BEING RATED: _____________________________________________________________ NAME OF PRIMARY CONTACT AT FIRM BEING RATED: ______________________________________________

2. NAME OF FIRM/AGENCY PROVIDING FEEDBACK: __________________________________________________ PROJECT NAME: ________________________________________________________________________ PERIOD OF PERFORMANCE: _________________ CONTRACT TYPE (if applicable): ________________________ CONTRACT AWARD DATE: __________________ CONTRACT COMPLETION DATE: _________________________ AWARDED VALUE: _______________________ CURRENT CONTRACT DOLLAR VALUE: ______________________

3. NAME OF ASSESSING OFFICIAL: ______________________________________________________________ EMAIL: ______________________________ PHONE NUMBER: ____________________________________ ASSOCIATION WITH FIRM BEING RATED (including role): ____________________________________________ CONTRACT OR ORDER NUMBER (if applicable): ___________________________________________________

4. ASSESS THE FOLLOWING AREAS: (Check the appropriate box for each assessment category)

Assessment Categories Unsatisfactory Marginal Satisfactory Very Good

Exceptional N/A

a. COMPLIANCE WITH LEASE

REQUIREMENTS

b. QUALITY OF SERVICES

c. TIMELY DELIVERY OF SERVICES

d. BUSINESS RELATIONS

e. MANAGEMENT OF KEY

PERSONNEL

f. RELIABILITY

g. CUSTOMER SUPPORT

h. OVERALL PERFORMANCE

i. OTHER AREAS:

(1)

(2)

5. ADDITIONAL COMMENTS:

PAST PERFORMANCE QUESTIONNAIRE

RLP No. ___________________________ Project Name: _______________________

COMPLETED BY:

SIGNATURE:

TITLE:

INSTRUCTIONS FOR REFERENCES COMPLETING THIS QUESTIONNAIRE:

VA requests that the reference completes this questionnaire and submits it directly back to VA’s Contract Officer, at Lisa.Newlin@va.gov no later than _______PM Local Time on ___________________, with a subject line that reads “RLP 36C25024R0209 [Name of Offeror], Completed Past Performance Questionnaire”.

The Government reserves the right to verify all information on this form.

1 NAME OF FIRM BEING RATED NAME OF PRIMARY CONTACT AT FIRM BEING RATED:
NAME OF FIRMAGENCY PROVIDING FEEDBACK:
PROJECT NAME:
PERIOD OF PERFORMANCE:
CONTRACT TYPE if applicable:
CONTRACT AWARD DATE:
CONTRACT COMPLETION DATE:
AWARDED VALUE:
CURRENT CONTRACT DOLLAR VALUE:
NAME OF ASSESSING OFFICIAL:
EMAIL:
PHONE NUMBER:
ASSOCIATION WITH FIRM BEING RATED including role:
CONTRACT OR ORDER NUMBER if applicable:
Unsatisfactorya COMPLIANCE WITH LEASE REQUIREMENTS:
Marginala COMPLIANCE WITH LEASE REQUIREMENTS:
Satisfactorya COMPLIANCE WITH LEASE REQUIREMENTS:
Very Gooda COMPLIANCE WITH LEASE REQUIREMENTS:
Exceptionala COMPLIANCE WITH LEASE REQUIREMENTS:
NAa COMPLIANCE WITH LEASE REQUIREMENTS:
Unsatisfactoryb QUALITY OF SERVICES:
Marginalb QUALITY OF SERVICES:
Satisfactoryb QUALITY OF SERVICES:
Very Goodb QUALITY OF SERVICES:
Exceptionalb QUALITY OF SERVICES:
NAb QUALITY OF SERVICES:
Unsatisfactoryc TIMELY DELIVERY OF SERVICES:
Marginalc TIMELY DELIVERY OF SERVICES:
Satisfactoryc TIMELY DELIVERY OF SERVICES:
Very Goodc TIMELY DELIVERY OF SERVICES:
Exceptionalc TIMELY DELIVERY OF SERVICES:
NAc TIMELY DELIVERY OF SERVICES:
Unsatisfactoryd BUSINESS RELATIONS:
Marginald BUSINESS RELATIONS:
Satisfactoryd BUSINESS RELATIONS:
Very Goodd BUSINESS RELATIONS:
Exceptionald BUSINESS RELATIONS:
NAd BUSINESS RELATIONS:
Unsatisfactorye MANAGEMENT OF KEY PERSONNEL:
Marginale MANAGEMENT OF KEY PERSONNEL:
Satisfactorye MANAGEMENT OF KEY PERSONNEL:
Very Goode MANAGEMENT OF KEY PERSONNEL:
Exceptionale MANAGEMENT OF KEY PERSONNEL:
NAe MANAGEMENT OF KEY PERSONNEL:
Unsatisfactoryf RELIABILITY:
Marginalf RELIABILITY:
Satisfactoryf RELIABILITY:
Very Goodf RELIABILITY:
Exceptionalf RELIABILITY:
NAf RELIABILITY:
Unsatisfactoryg CUSTOMER SUPPORT:
Marginalg CUSTOMER SUPPORT:
Satisfactoryg CUSTOMER SUPPORT:
Very Goodg CUSTOMER SUPPORT:
Exceptionalg CUSTOMER SUPPORT:
NAg CUSTOMER SUPPORT:
Unsatisfactoryh OVERALL PERFORMANCE:
Marginalh OVERALL PERFORMANCE:
Satisfactoryh OVERALL PERFORMANCE:
Very Goodh OVERALL PERFORMANCE:
Exceptionalh OVERALL PERFORMANCE:
NAh OVERALL PERFORMANCE:
Unsatisfactoryi OTHER AREAS:
Marginali OTHER AREAS:
Satisfactoryi OTHER AREAS:
Very Goodi OTHER AREAS:
Exceptionali OTHER AREAS:
NAi OTHER AREAS:
1:
Unsatisfactory1:
Marginal1:
Satisfactory1:
Very Good1:
Exceptional1:
NA1:
2:
Unsatisfactory2:
Marginal2:
Satisfactory2:
Very Good2:
Exceptional2:
NA2:
5 ADDITIONAL COMMENTS:
Name of Firm:
Contact Name:
RLP No: 36C25024R0209
Project Name: West Branch VA Clinic
Completed by:
Title:
Time: 12:00
Date: 04/15/2025

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