Past Performance Questionnaire.docx
DOCX document 29 KB Posted
- Attached to
- Q301--Indianapolis Reference Laboratory Testing Federal contract opportunity
- Solicitation number
- 36C25025Q0230
About this file
The document is a Past Performance Questionnaire for a Reference Laboratory Testing Services Request for Quote (RFQ) from the Department of Veterans Affairs (VA), specifically for the Indianapolis VA Medical Center. The questionnaire is designed to collect detailed performance feedback from previous customers, with a focus on evaluating the contractor's capabilities across multiple performance metrics including IT systems connectivity, support quality, test menus, turnaround times, specimen handling, and educational materials.
The questionnaire provides a comprehensive evaluation framework with four performance ratings (Superior, Satisfactory, Unsatisfactory, Neutral) across several key performance indicators. It seeks to gather insights about the contractor's past performance, including specific strengths and weaknesses, contract termination history, and willingness of previous customers to recommend the contractor for future work. The solicitation is specifically identified as RFQ #36C25025Q0230 for Reference Laboratory Testing Services at the Indianapolis VA Medical Center, and requires potential vendors to submit performance references as part of their proposal package.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Price Schedule - Indy Reference Lab .xlsx | XLSX spreadsheet | |
| Attachment 1 - Declining Balance Spreadsheet.xlsx | XLSX spreadsheet | |
| 36C25025Q0230 0001 Amendment Indy Reference Lab Solicitation.docx | DOCX document | |
| Price Schedule.xlsx | XLSX spreadsheet | |
| 36C25025Q0230.docx | DOCX document |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Reference Laboratory Testing Services
RFQ# ___________________________
PART ONE: INSTRUCTIONS
The company who has provided you with this form is proposing on reference laboratory testing services solicitation. Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important. Please provide an honest assessment and return the questionnaire to the vendor by promptly so the vendor can provide in their solicitation package.
If you have any questions about this request, please contact: Jessica.Bryant5@va.gov.
PART TWO: GENERAL INFORMATION
1. OFFEROR’S NAME AND ADDRESS: _____________________________________
2. CUSTOMER ORGANIZATION: _____________________________________
CUSTOMER POINT OF CONTACT/EVALUATOR:
| NAME: | ___________________________________ | |
| TITLE: | ___________________________________ | |
| PHONE NO: | ___________________________________ |
| 3. Contract Number: | ___________________________________ | |
| 4. Contract Value: | ___________________________________ | |
| 5. Period of Performance: | ___________________________________ | |
| 6. Contract Type: | ___________________________________ |
7. Complexity of Work:
____DIFFICULT ____ROUTINE
8. Brief Description of Your Contract Requirements:
PART THREE: OFFEROR PERFORMANCE RATINGS
On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set pf sub-factors with four possible confidence ratings. Determine the adjectival rating that most nearly represents experience with this offeror and indicate assessment by placing an “X” under the appropriate heading.
Adjectival ratings are defined below and should be used as a reference in assessing performance:
| RATING |
| DEFINTION |
| Superior |
| Based on the offeror’s past performance record, it is highly likely that the offeror will successfully perform the required effort |
| Satisfactory |
| Based on the offeror’s past performance record, it is likely that the offeror will successfully perform the required effort. |
| Unsatisfactory |
| Based on the offeror’s past performance record, it is not likely that the offeror will successfully perform the required effort. |
| Neutral |
| No relevant performance record is identifiable upon which to base a meaningful performance rating. A search was unable to identify any relevant past performance information for the offeror, key personnel, or subcontractors. This is neither a negative nor positive assessment. |
| Superior |
| Satisfactory |
| Unsatisfactory |
| Neutral |
Transmission/Connectivity to your IT systems
Quality of IT Support
Startup Time from contract award to contract start date
Test Menus
Turn Around Times
Notification of Specimen Evaluation Viability
Metrics for Critical Results
Specimen Pick-Up Time
Continuing Education Materials (PACE, CME, and CE)
1. Has this contract been partially terminated for default or convenience?
___ YES ___ Default ___Convenience
___ NO
If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules – also include contract number, name, and phone number of Termination Contracting Officer – TCO)
2. What was the Contractor’s greatest strength in the performance of the contract?
3. What was the Contractor’s greatest weakness in the performance of the contract?
4. Would you award another contract to this contractor?
____ YES ___NO
COMMENTS:
PART FOUR: EVALUATOR’S CERTIFICATION
I hereby certify that the information in this form is accurate and complete to the best of my knowledge.
| SIGNED: | ___________________________________________ | |
| TITLE: | ___________________________________________ |
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