36C25218R0105-008.docx

Multiple Award Task Order Contract (MATOC) 36C25218R0105 Solicitation Attachment 6 Past Performance Client Questionnaire

(SAMPLE TRANSMITALL LETTER TO BE SENT FROM CONTRACTOR

<Your Company Letterhead>

Date: ___________________

To:

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm will be submitting a proposal under a solicitation advertised by Department of Veterans Affairs, Network Contracting Office 12 (NCO 12), located at 115 South 84th Street, Suite 101, Milwaukee, WI 53214.

In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance; your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible.

Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306 (e) (4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address. Do NOT return them directly to our company.

via email to: megan.manis@va.gov

If you have questions regarding the attached questionnaire, please contact Megan Manis at megan.manis@va.gov.

Please be advised that “E-Mail” is the only method of receiving the requested information.

Thank you for your assistance.

<Signature and Title of Offeror’s Principal>

PAST PERFOMANCE QUESTIONNAIRE

1.) GENERAL INFORMATION on Contractor being evaluated

Name of Contractor:

Point of Contact: Title: E-mail:

Address of Record: Office Phone: Fax:

Contract#: Dollar Amount:

Dates of Performance:

Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor |_|Key Personnel

Project Title and Brief Description of Work:

*Note: If Contractor holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

2.) RESPONDENT CLIENT INFORMATION

(Person providing comments on Contractor Performance)

Respondent Name: Title:

E-mail: ______________________________ Office phone: _______________

Address of Record:

3.) TRANSMITTAL INSTRUCTIONS: E-mail completed survey to Megan Manis, Network Contracting Office 12 (NCO 12) at megan.manis@va.gov.

4.) PERFORMANCE INFORMATION: Choose the appropriate adjectival rating that most accurately describes the contractor’s performance.

TO BE COMPLETED BY RESPONDENT CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

3. CUSTOMER SATISFACTION:

4. MANAGEMENT/ PERSONNEL/LABOR

Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

5. COST/FINANCIAL MANAGEMENT

Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes

No

6. SAFETY/SECURITY

7. GENERAL

Would you hire or work with this firm again? (If no, please explain below)

Yes

No

Please provide frank responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (attach additional pages if necessary):

SOURCE SELECTION SENSITIVE Page 5 of 5 Attachment 6 FAR 2.101 and 3.104.-4