Exhibit F_Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Please complete and email to Melissa Brau, Melissa.brau@va.gov with the RLP #36C255-24-R-0004: , name of offeror, and "Completed Past Performance Questionnaire for Derm & Diabetes VA Clinic" in the subject line.

Evaluator’s Company/Organization:

Name of Evaluator:

Duty Position/Title:

I. CONTRACTOR INFORMATION: Please complete the following questionnaire on the below-listed contractor who has provided leasing related services in the past or is currently providing leasing related services for your company/organization. If any information is incorrect or incomplete please provide the complete accurate information.

a. Contractor (Company/Name):

Point of Contact:

b. Contractor Address:

Telephone:

c. Contract Information:

1. Number:

2. Type of Contract:

3. Technical Complexity of Work:

4. Period of Performance:

5. Total Contract Amount:

6. Services Provided (Explain, in some detail, the type of services provided by the contractor):

mailto:Melissa.brau@va.gov

II. PERFORMANCE INFORMATION: When responding to the following statements, choose the number on the scale of 1 to 4, based on the corresponding adjective definitions described below, which most accurately describes the Contractor's performance under the subject contract effort. If the statement is not applicable to the circumstance of this contract effort, circle N/A. The numbers correspond with the following adjective ratings:

1 2 3 4 N/A Unsatisfactory Marginal Acceptable Outstanding Not Applicable

ADJECTIVE RATING DEFINITIONS:

Outstanding: They are an exceptional firm in every respect. Problems were solved in a spirit of teamwork. Quality work, timely actions, and complete documentation were routinely achieved. We would pay premium prices to contract with them again. Based on the offeror’s performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

Acceptable: They were a satisfactory Contractor who met the minimum requirements of the contract.

Performance deficiencies improved when identified by the Government. Although rework/warranty issues were performed, an aggressive inspection program was required to ensure compliance. Based on the offeror’s performance record, some doubt exists that the offeror will successfully perform the required effort.

Marginal: They were a marginal Contractor. Numerous problems developed that were a result of their lack of cooperation and failure to perform work, as required. Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve contract requirements.

Unsatisfactory: They were an unsatisfactory Contractor. We would not want to contract with this firm again under any circumstances. Based on the offeror’s performance record, extreme doubt exists that the offeror will successfully perform the required effort.

THE CONTRACTOR…

1. Developed realistic delivery schedules, met established project schedules, and conformed to contract requirements.

1 2 3 4 N/A

COMMENTS/REMARKS:

2. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. Demonstrated ability to replace personnel, if necessary, without delay or impact to contract performance.

1 2 3 4 N/A

COMMENTS/REMARKS:

3. Utilized quality and dependable suppliers.

1 2 3 4 N/A

COMMENTS/REMARKS:

4. Provided effective quality control, which resulted in supplies/services being delivered/performed in accordance with the provisions of the contract.

1 2 3 4 N/A

COMMENTS/REMARKS:

5. Identified problems as they occurred. Suggested alternative approaches to problems. Displayed initiative to solve problems.

1 2 3 4 N/A

COMMENTS/REMARKS:

6. Requested additional, or clarification information at appropriate times to solve issues regarding contract performance, customer satisfaction, or Contracting Officer needs.

1 2 3 4 N/A

COMMENTS/REMARKS:

7. Responded to emergency situations by promptly assessing the scope, providing accurate proposals, negotiating price and performance schedule, and timely performance in meeting customer needs.

1 2 3 4 N/A

COMMENTS/REMARKS:

8. Provided timely, accurate, complete and reasonable prices on items that met the requirements of the project or modification.

1 2 3 4 N/A

COMMENTS/REMARKS:

9. Provided accurate invoices.

1 2 3 4 N/A

COMMENTS/REMARKS:

10. Has the Contractor ever been given a Cure Notice, Show Cause Notice, Letter of Concerns, or had payment withheld for services not rendered?

Yes No

IF YES, PLEASE EXPLAIN:

11. Provided timely resolution of warranty defects?

1 2 3 4 N/A

COMMENTS/REMARKS:

12. Has the contractor demonstrated reasonable and cooperative behavior and commitment to customer satisfaction; and does the contractor demonstrate a business-like concern for the interests of its customers.

1 2 3 4 N/A

COMMENTS/REMARKS:

Please provide any additional comments or remarks you feel may be useful in evaluating the respective contractor below:

Thank you for your time and effort in completing this Past Performance Questionnaire.