36C25619R0083-003.pdf

FOR OFFICIAL USE ONLY

Elevator PMR Service Contract

Jackson, MS 36C25619R0083

ATTACHMENT 2 : PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO CONTRACTOR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes).

Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.

INSTRUCTIONS TO REFERENCE CONTACT

The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact. Please complete this form in full (all areas shaded in light yellow, below). Once completed, please send the form to the

Contract Specialist via postal mail or email, directly to:

Department of Veterans Affairs NCO 16 Contracting Office

ATTN: Jennifer Adams, Contract Specialist REF: 36C25618R0083

Ridgeland, MS 39157 Email Address: Jennifer.adams7@va.gov

Please return the completed form no later than June 21, 2019, 4:00 pm CST. If you have any questions, please contact Ms. Adams via email, or call 601-206-6955. Thank you for your assistance in this matter.

GENERAL INFORMATION [completed by Contractor]

Contractor

Company Name Street Address

Contractor Point of

Contact Name City

Point of Contact

Phone Number State

Reference Project

Title Zip Code

Contract Period of

Performance (start to finish): Email

Contract Number

Contract Dollar

Value

Description of

Work

Role of Contractor on This Project

(check appropriate box) ☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel

RESPONDENT INFORMATION [completed by Reference Contact]

Company Name Street Address mailto:Jennifer.adams7@va.gov

Jackson, MS 36C25619R0083

POC Name City

Phone Number State

Fax Number Zip Code

Email

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY

RATINGS OF 1 OR 2 in the Remarks section, below (text box will expand to whatever extent is necessary).

1 2 3 4 5 6

UNSATISFACTORY MARGINAL SATISFACTORY VERY GOOD EXCEPTIONAL NEUTRAL

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance met contractual requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

No record of past performance or the record is inconclusive.i

The Contractor … 1 2 3 4 5 6

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Home office participated in solving significant local problems.

5. Followed approved quality control plan.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

8. Provided timely resolution of contract discrepancies

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules.

Jackson, MS 36C25619R0083

13. Met established project schedules.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

18. Paid subcontractors/suppliers in a timely manner.

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

20. Cooperated with Government personnel after award. ☐ ☐ ☐ ☐ ☐ ☐

21. How would you rate the contractor's overall performance? ☐ ☐ ☐ ☐ ☐ ☐

22. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

☐ YES ☐ NO

23 Would you award another contract to this contractor? If not, please explain in “remarks.”

☐ YES ☐ NO

24 To the best of your knowledge, is the contractor rated in CPARS? ☐ YES ☐ NO

REMARKS (Please use as much space as is needed – the box will expand as you type).

Printed Name

Title

Signature