36C25618R0298-003.pdf

Attachment B 36C25618R0298

Past Performance Questionnaire Instructions

The “offeror” (identified in Section I, Block A) is submitting a response to a solicitation issued by the Department of Veterans Affairs, VA Gulf Coast Veterans Health Care System (VA) for transport of laundry services to be performed in Alexandria, LA, Jackson, MS and Biloxi, MS.

Your candid responses to this questionnaire will assist VA in evaluating the offeror’s past performance (i.e. How was the quality of the services this offeror provided in the past?). By gathering this information (not only on this offeror, but on all the companies who submit an offer to provide these required services) we strive to determine which company’s offer will be most advantageous to VA.

We appreciate the time and effort you take to verify the information provided by the offeror in Section I and more importantly to complete Sections II and III regarding the services you received from them. It is the Offeror’s responsibility to follow-up with references.

PLEASE E-MAIL COMPLETED Questionnaires NLT March 13, 2018; 12:00 (Noon) CST to:

Jennifer.adams7@va.gov

Section I - Details of Company Being Evaluated) (To be Filled Out by the “Offeror (a.k.a. “Evaluatee”)“ & Verified by the “Evaluator”)

A. Offeror’s Information:

1. Company Name:

2. Address:

3. Company POC’s Name:

4. POC’s Title:

5. POC’s Phone #:

6. POC’s Fax #:

7. POC’s Email:

B. Information regarding Past Contract(s*) being evaluated: *(attach additional pages if necessary)

1. Contract #:

2. Customer (Firm Name):

3. Performance Period when was work done.

4. Location(s) of Work Performed:

5. Scope of Contract (i.e. Brief Description of Work Performed):

6. Average Annual $ amount:

7. Awards or Incentives (if applicable) mailto:Jennifer.adams7@va.gov

SECTION II - Details of Evaluator (Person providing Evaluation of Offeror) (Can be Filled Out by either the “Offeror “ OR “Evaluator”)

1. Evaluator’s Name:

2. Title:

3. Organization:

4. Evaluator’s Phone #:

5. Evaluator’s Fax #:

6. Evaluator’s Email:

SECTION III - Customer Satisfaction/Quality of Service Questions (To be Filled Out only by the “Evaluator”)

EXPLANATION OF CODES:

CODE PERFORMANCE LEVEL

O OUTSTANDING- Performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

E EXCELLENT- Performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A ACCEPTABLE- Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL- Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY- Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE or UNKNOWN- Unable to provide a score. Performance in this area not applicable to the effort assessed.

KEY: 5=OUTSTANDING 4=EXCELLENT 3=ACCEPTABLE 2=MARGINAL 1=UNACCEPTABLE

0=UNKNOWN

1. How satisfied are you with the overall performance this offeror provided? 5 4 3 2 1 0

2. To what degree did this offeror conform to your contract’s requirements? 5 4 3 2 1 0

3. How effective was this offeror in establishing and maintaining a positive working relationship?

5 4 3 2 1 0

4. Were any awards or incentives given for excellent performance? Yes No 0

5. To what extent did the contractor respond to and attempt to correct any concerns, issues, or problems that appeared during performance of your contract?

5 4 3 2 1 0

6. What extent was this offeror flexible in responding to changing needs? 5 4 3 2 1 0

7. How would you rate the effectiveness of the contractor’s problem resolution efforts?

5 4 3 2 1 0

8. Did this offeror submit complete and accurate invoices for payment of services provided? If not, was the offeror willing to correct them?

Yes No 0

9. Did this offeror generally meet performance schedule? 5 4 3 2 1 0

10. To what degree did this offeror provide the right personnel and number of personnel to complete your requirement in a timely manner?

5 4 3 2 1 0

11. To what degree did this offeror provide the right types and quantities of supplies to complete your requirement in a timely manner?

5 4 3 2 1 0

12. To what degree did this offeror provide the right types and quantities of equipment to complete your requirement in a timely manner?

5 4 3 2 1 0

13. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain below.

Yes No 0

14. If given an opportunity, how likely is it you would conduct business with this offeror again?

5 4 3 2 1 0

Section IV: Closing Comments

1. Provide any additional comments you feel would be pertinent regarding past performance of this company: