36C25719Q0423-005.docx
DOCX document 32 KB Posted
- Attached to
- Regulated Medical Waste and Sharps Disposal Services for South TX VA Medical Facilities Federal contract opportunity
- Solicitation number
- 36C25719Q0423
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36C25719Q0423 Attachment 3 - Past Performance Questionnaire.docx
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| File | Type | Posted |
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| -16904.docx | DOCX document | |
| 36C25719Q0423-0001002.docx | DOCX document | |
| 36C25719Q0423-0001000.docx | DOCX document | |
| 36C25719Q0423-0001001.docx | DOCX document | |
| 36C25719Q0423-001.pdf | ||
| 36C25719Q0423-003.docx | DOCX document | |
| 36C25719Q0423-002.pdf | ||
| 36C25719Q0423-004.docx | DOCX document | |
| 36C25719Q0423-006.docx | DOCX document | |
| 36C25719Q0423-000.docx | DOCX document |
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36C25719Q0423 Regulated Medical Waste Disposal and Sharps Program - STX
ATTACHMENT 3
| FROM: | Contracting Officer |
| NCO 17 - Contracting Office |
SUBJECT: Request for Past/Present Performance Information
1. You have been identified as a point of contact for a past and/or present performance evaluation of ______________________________________. This firm is currently being considered for a contract at the South Texas Veterans HealthCare System (STVHCS) facilities.
2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed worksheet directly to Antonio Jackson: antonio.jackson@va.gov / NLT April 4, 2019. Questionnaires shall not be sent back to the Contractor. If you have any questions or concerns regarding this request, please contact Antonio Jackson at 210-694-6328 or by email at the address listed above.
Past Performance Questionnaire
SECTION A.1: Contractor and Project Information (to be completed by the contractor (offeror) prior to sending to references.
A. Contractor’s name and address: _________________________________________
B. Project Owner -POC: _________________________________________
| C. Phone: | _________________________________________ | |
| D. Email Address: | _________________________________________ |
D. Contract Number: _________________________________________ E. Project Title/Desc of Work: _________________________________________
| _________________________________________ | ||
| F. Contract Type: | _________________________________________ | |
| G. Project Award Date: ______________ | Scheduled Completion Date: ________________ |
Current/Final Completion Date: ________________
H. Project Award Amount: ____________ Current/Final Project Amount: ________________
I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier
A.2: EVALUATED BY: (to be completed by Past/Current Project Owner)
(Signature) (Date)
_____________________________________ Address: _____________________________ (Typed or Printed Name) _____________________________________ (Title)
(Phone/Fax/Email)
| A |
| B |
| C |
| D |
NA
| Substantial Confidence |
| Satisfactory Confidence |
| Limited Confidence |
| No |
Confidence
Unknown Confidence
| Based on the offeror’s performance record, there is a high expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is an expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is low expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is no expectation that the offeror will successfully perform. |
No performance record is identifiable or the offeror’s performance record is so sparse that no rating can be reasonably assigned.
EVALUATION AREAS
I. Quality A B C D NA
| 1. |
| Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor performed IAW the SOW and guidance of COR and CO. |
| □ |
| □ |
| □ |
| □ |
II. Timely Performance A B C D NA
| 1. |
| Contractor met established project schedules to complete the project on time. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor performed all work without the issuance of a cure notice or show cause letter. (If a notice was issued, please describe the circumstances on a separate sheet of paper and identify if liquidated damages were assessed.) |
| □ |
| □ |
| □ |
| □ |
III. Management Effectiveness A B C D NA
| 1. |
| Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
| □ |
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| 3. |
| Contractor hired, maintained, and replaced as necessary, qualified personnel and subcontractors/suppliers. |
| □ |
| □ |
| □ |
| □ |
| 4. |
| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule. |
| □ |
| □ |
| □ |
| □ |
| 5. |
| Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution. |
| □ |
| □ |
| □ |
| □ |
IV. Compliance with Safety Standards A B C D NA
| 1. |
| Adequacy of Safety Plan |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Implementation of Safety Plan |
| □ |
| □ |
| □ |
| □ |
V. Overall Performance A B C D NA
| 1. |
| Please rate the contractor’s overall performance |
| □ |
| □ |
| □ |
| □ |
Additional Information:
(1) Identify the contractor's overall strengths and weaknesses.
(2) Given the choice, would you award to this contractor again?
(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.
(If more comment space is needed, write on back or attach pages.)
Thank you for taking the time to complete this questionnaire. If you have any additional comments or questions, you can contact Antonio Jackson at 210-694-6328 or antonio.jackson@va.gov image1.wmf
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