36C25619R0073-024.doc
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- Attached to
- 580-320 Construct Spinal Cord Injury Expansion Federal contract opportunity
- Solicitation number
- 36C25619R0073
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36C25619R0073 ATTACHMENT W - Past Performace Questionnaire.doc
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OFFEROR:
SOURCE SELECTION SENSITIVE WHEN COMPLETED*****NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS***** RETURN THIS PAGE WITH QUESTIONAIRE
RATING DESCRIPTIONS: Use the following descriptions as guidance in providing ratings.
| RATING |
| DEFINITION |
| Exceptional (E) |
| Indicates the contractor’s performance record within the area of evaluation Exceeded that required by the contract. |
| Very Good (VG) |
| Indicates the contractor’s performance record within the area of evaluation Met All contractual requirements. |
| Satisfactory (S) |
| Indicates the contractor’s performance record within the area of evaluation Met Essentially All contractual requirements. |
| Marginal (M) |
| Indicates the contractor’s performance record within the area of evaluation Met Some of the contractual requirements. However, changes to the contractor’s existing processes may be necessary in order to achieve contract requirements. |
| Unsatisfactory (U) |
| Indicates the contractor’s performance record within the area of evaluation Failed to Meet the minimum Government requirements. |
| Unknown or Not Applicable (N/A) |
| The question does not apply. No performance record identifiable within the area of evaluation. |
RESPONDENT IDENTIFICATION AND RATINGS
(Part 1 Contractor submitting Proposal fill-in)
Reference is provided for:
Contract Number or Project Title:
Location:
Dollar Amount:
Brief Description of work and your role in the referenced contract:
(Part 2 Person providing Reference) Reference is provided by:
Company/Agency:
Business Address:
Telephone Number:
E-Mail Address:
Relationship to Contract:
If information in Part 1 is not accurate please indicate.
THE QUESTIONNAIRE SHALL BE SUBMITTED BY THE REFERENCE TO Tabitha.contreras@va.gov PRIOR TO THE CLOSING DATE OF THE SOLICITATION.
QUALITY- MANAGEMENT AND WORKMANSHIP
(1) How well did the Offeror utilize quality control process that ensured conformance to scope and quality requirements?
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (2) Adequacy of Submittals. Were submittals well researched and did they clearly identify the proposed item? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (3) Did reports / records submitted completely and accurately satisfy requirements? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
TIMELINESS AND ADHERENCE TO SCHEDULE:
(4) Timeliness in completing the project
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (5) Did the contractor provide timely notices of delays/schedule revisions? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (6) Timeliness in submitting submittals and reports and responding to agency inquiries, RFP's, etc. |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (7) Did the contractor provide adequate, competent and qualified management, key personnel and technical personnel capable of meeting contract requirements throughout the performance period of the contract and did contractor comply with specifications? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (8) How well did the contractor work independent of Government guidance, oversight and assistance? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (9) Did contractor maintain a good relationship with agency contracting and technical/project mgt. personnel? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
(10) How effective was the contractor in meeting Cost/Price performance targets and controlling costs (i.e. changes, etc.)? Did they demonstrate reasonableness in modifications scope and costs?
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (11) Were Subcontractors / tradesmen adequately managed and coordinated? Explain any subcontracting issues (positive or negative) that impacted the performance of your contract(s). |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (12) How flexible, cooperative, and reasonable was the contractor in meeting mission requirements, particularly when faced with short-notice mission changes? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (13) How timely and effective were the contractor’s responses to and resolution of Technical problems? Did the Site Manager have sufficient authority to make decisions or take actions during project performance? ( ) yes ( ) no |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
(14) How effective was the offeror’s environmental program, oversight, project management and QC staff?
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (15) Was the Site Manager consistently present on site when work was performed? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (16) How effective was the contractor’s safety program to ensure compliance with federal, state and local regulations? Did the contractor implement and follow their safety plan? Did they run a “safe jobsite”? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (17) Applicable to Federal Contracts – How well did the contractor comply with applicable Federal Laws and Regulations such as Davis Bacon Act – timely payrolls and compliance; Drug-Free Workplace; Environmental Regulations and Use of Recovered Materials; Executive Order 13101? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
Infection Control
| (18) Did the contractor have an Infection Control Process in place and how well did the contractor comply with agency Infection Control Requirements? |
| E |
| VG |
| S |
| M |
| U |
| NA |
REMARKS:
| (19) How would you rate the Contractor’s overall performance? |
| E |
| VG |
| S |
| M |
| U |
| NA |
Thank you for your remarks. Be sure to return to the Contracting Agency and not to the Contractor you are providing a reference for.
OFFEROR NAME:
Respondent Signature: ______________________________________ Date Completed:
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