P09 Final Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

Solicitation Number: 36C25025C0037 Paratransit/Special Needs Transportation Services

MESSAGE TO THE EVALUATOR: Your assistance is requested by the below Contract Specialist with Network Contracting Office (NCO) 10, to assist with establishing the performance history for the Company (Offeror) named below. In efforts to expedite receipt of the requested information, the Contract Specialist respectively requests you do not mail hard copies.

Instead, please email the complete past performance questionnaire(s) to: Andrea.Roach2@va.gov by 01/31/2025 at 10:00 AM, Eastern Time.

If enough space is not provided, please attach additional information to this questionnaire.

PAST PERFORMANCE EVALUATION

Part I

a. Contractor:

b. Contract number:

c. Contract type:

d. Was this a competitive contract? Yes ☐ No ☐

e. Period of performance:

f. Initial contract price: $____________________________

g. Current/final contract price: $____________________________

CUSTOMER OR AGENCY IDENTIFICATION

a. Customer or agency name: ________________________________________________________

b. Customer or agency description (if applicable):

c. Geographic description of services under this contract, i.e., local, nationwide, worldwide, other commands: ____________________________________________________________________

EVALUATOR IDENTIFICATION

a. Evaluator’s name:

b. Evaluator’s title:

c. Evaluator’s phone:

d. Evaluator’s email: _________________________________

e. Number of year’s evaluator worked on subject contract:

Part II Please indicate your satisfaction with the contractor’s performance by circling the appropriate number using the scale provided. This scale is defined as follows:

Performance Assessment

PERFORMANCE

P1. Was the contractor’s work performed in a skillful and good workmanship like manner?

U ☐ M ☐ A ☐ O ☐

P2. Did the contractor conform to the terms and conditions of the contract?

U ☐ M ☐ A ☐ O ☐

P3. Was the contractor reasonable and cooperative during and after contract performance?

U ☐ M ☐ A ☐ O ☐

P4. Did the contractor submit paperwork timely and completely?

U ☐ M ☐ A ☐ O ☐

P5. Did the contractor coordinate and keep control of the subcontractors?

U ☐ M ☐ A ☐ O ☐

P6. Did the contractor comply with laws, regulations, and facility rules?

U ☐ M ☐ A ☐ O ☐

P7. Evaluate the Contractor’s overall quality of work under the contract?

U ☐ M ☐ A ☐ O ☐

P8. Has the contractor encountered any patient safety incidents that involved other moving/parked vehicles, or fixed object?

U ☐ M ☐ A ☐ O ☐

If yes, please state if the incident was reported to the appropriate authorities.

P9. Has the contractor encountered any patient safety incidents that were caused by negligence?

U ☐ M ☐ A ☐ O ☐

If yes, please state if the incident resulted in the patient needing medical attention.

Provide any explanation you may feel is required to clarify any of the above responses:

Part III Narrative Summary

a. What were the contractor’s greatest strengths in the performance of the contract?

b. What were the contractor’s greatest weaknesses in the performance of the contract?

c. Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

d. Are there any other issues not covered you feel important to note about performance of this contractor?

Part IV Government contracts only: Has/was this contract partially or completely terminated for default or convenience or are there any pending terminations?

Yes ☐ : Default ☐ Convenience ☐ Pending Terminations ☐ or NO ☐

If yes, explain (e.g., inability to meet price, performance, or delivery schedules, etc.)

Considering all the information provided above, please rate the contractor’s performance overall.

U M A O

Evaluator’s Signature Date