S02 SOL 0004 AttM Past Performance Client Questionnaire 585-21-115.pdf

SOURCE SELECTION SENSITIVE

FAR 2.101 and 3.104.-4

Solicitation 36C25225R0004 – Attachment M Page 1 of 6

585-21-115 Expand Boiler Plant

Solicitation Attachment M

Past Performance Client Questionnaire

(SAMPLE TRANSMITALL LETTER TO BE SENT FROM CONTRACTOR TO

REFERENCE)

<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 necessary.

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

If you have questions regarding the attached questionnaire, please contact Contracting Officer

Kristi Kluck, 414-844-4879. Submit responses to email: kristi.kluck3@va.gov.

Thank you for your assistance.

<Signature and Title of Offeror’s Principal> mailto:kristi.kluck3@va.gov

Solicitation 36C25225R0004 – Attachment M Page 2 of 6

PAST PERFOMANCE QUESTIONNAIRE

1.) GENERAL INFORMATION on Contractor being evaluated

Company Being Evaluated: Point of Contact:

Title: E-mail: Phone:

Address of Record:

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)

Evaluator (Company and Point of Contact)

Title: E-mail: Phone:

Address of Record:

3.) TRANSMITTAL INSTRUCTIONS: E-mail completed survey to Kristi.Kluck3@va.gov, Department of Veterans Affairs, Network Contracting Office 12 (NCO 12).

mailto:Kristi.Kluck3@va.gov

Solicitation 36C25225R0004 – Attachment M Page 3 of 6

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

Exceptional (E) Based on the Offeror’s overall past performance subfactor ratings, essentially no doubt exists that the Offeror will successfully perform

ABOVE AND BEYOND the required effort.

Good (G) Based on the Offeror’s overall past performance subfactor ratings, little doubt exists that the Offeror will successfully perform ALL the required effort.

Satisfactory (S) Based on the Offeror’s performance record, some doubt exists that the Offeror will successfully perform MOST of the required effort.

Marginal (M) Based on the Offeror’s overall past performance subfactor ratings, substantial doubt exists that the Offeror will successfully perform

MOST the required effort. Changes to the Offeror’s existing processes may be necessary in order to achieve contract requirements.

Unsatisfactory (U) Based on the Offeror’s overall past performance subfactor ratings, extreme doubt exists that the Offeror will successfully perform the required effort.

Neutral / Not

Applicable or

Unknown (N)

No performance record identifiable within the area of evaluation.

TO BE COMPLETED BY RESPONDENT CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

Quality of technical data/reports preparation efforts

(submittals, schedule, etc.).

E G S M U N

Ability to meet quality standards specified for technical performance.

E G S M U N

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

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Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

(without adverse effect on performance).

E G S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

Compliance with contract delivery/completion schedules, including intermediate milestones.

E G S M U N

Contractors use of available resources to accomplish tasks identified in the contract.

E G S M U N

3. CUSTOMER SATISFACTION:

End Users were satisfied with the final product. E G S M U N

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E G S M U N

Contractor was cooperative, businesslike, and concerned with the interests of the customer?

E G S M U N

Overall customer satisfaction. E G S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force.

E G S M U N

Ability to hire, apply, and retain a qualified workforce to this effort E G S M U N

Government Property Control. E G S M U N

Knowledge/expertise demonstrated by contractor personnel E G S M U N

Utilization of Small Business concerns. E G S M U N

Ability to simultaneously manage multiple projects with multiple disciplines.

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

E G S M U N

Effectiveness of overall management (including ability to effectively lead, manage and control the program)

5. COST/FINANCIAL MANAGEMENT

Ability to meet the terms and conditions within the contractually agreed price(s).

E G S M U N

Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client.

E G S M U N

If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate backup documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances

(under runs or overruns).

E G S M U N

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

Yes

No

6. SAFETY/SECURITY

Contractor was able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.).

E G S M U N

Contractor complied with all security requirements for the project and personnel security requirements.

E G S M U N

7. GENERAL

Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or

Contracting Officer in a timely manner regarding urgent contractual issues).

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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):

Compliance with contractual terms/provisions (explain if specific issues) E G S M U N

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

Yes No

In summary, provide an overall rating for the work performed by this contractor.