36C25719Q0616-004.doc

NCO 17 – RPO WEST (36C25719Q0616 - SHUTTLE SERVICE)

Past Performance Questionnaire: The past performance questionnaire must be independently completed by the offeror’s client references. Offerors are responsible for ensuring that their client references complete this questionnaire and submit it via email directly to Matthew Clements at Matthew.Clements2@va.gov and Victoria Rone at Victoria.Rone3@va.gov 36C25719Q0616 - Shuttle Service in the subject line, NO LATER THAN THE DUE DATE AND TIME OF THE SOLICITATION.

[INSERT AGENCY/COMPANY NAME] PAST PERFORMANCE QUESTIONNAIRE

1.

Contractor Name:

Role on Project: (Prime/Subcontractor):

2.

Contract Number:

Contract Type:

____Firm Fixed Price

____T&M/LH

____Cost Reimbursement

____Other (Please Specify)______________

5.

Agency/Company Name:

6. Agency/Company POC/Phone/Email:

7.

Period of Performance:

8.

Dollar Amount at Award: $______________

Annual Amount: $_____________________

Total Dollar Value with Mods:$___________

9.

Title of Contract:

10.

Description of Contract Service/Scope of Contract:

11.

Complexity of Work: Difficult: ____ Moderate: ____ Routine: _____

NOTE: Please use adjectival ratings for items A – C and E – G below.

Item D uses a numerical ratings scale 1 to 5. Ratings guidelines are provided on pages 4 & 5.

A.

Quality of Work

PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS EXCEPTIONAL OR UNSATIFACTORY

B.

Personnel – Knowledge, Skills and Abilities

PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS EXCEPTIONAL OR UNSATIFACTORY

C.

Cost/Budget Control

PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS EXCEPTIONAL OR UNSATIFACTORY

D.

Customer Satisfaction

PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS “5” (highest) OR “1” (lowest)

(1 – 5)

E.

Timeliness of Performance/ Deliverables PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS EXCEPTIONAL OR UNSATIFACTORY

F.

Business Relations

PLEASE PROVIDE COMMENTS, PARTICULARLY IF RATING ASSIGNED IS EXCEPTIONAL OR UNSATIFACTORY

G.

Overall Performance PLEASE PROVIDE COMMENTS, PARTICULARLY IF ASSIGNED RATING IS EXCEPTIONAL OR UNSATISFACTORY

15.

Would you select this contractor again? Please explain.

(Attach additional sheet if necessary.)

16.

Name and title of individual who completed this questionnaire:

17.

Date:

Past Performance Rating Guidelines Summarize contractor performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, and Exceptional. Use the following instructions as guidance in making these evaluations. Please use the comments area on the preceding form to justify the rating given.

Personnel Capabilities -Compliance w/contract requirements

-Accuracy of reports

-Appropriateness of personnel

-Technical excellence

Cost/Budget Control -Within budget

-Current, accurate, complete billings

-Relationship of negotiated costs to actual

-Cost efficiencies

-Change orders issued Customer Satisfaction

Customer Satisfaction is a measure of how products and services supplied by a company meet or surpass customer expectation.

On a scale of 1-5 (5 being the highest) please rate and describe your level of satisfaction with the contractor’s performance.

5 - Very satisfied

4 - Somewhat satisfied

3 - Neither satisfied nor dissatisfied

2 -Somewhat dissatisfied

1 - Very dissatisfied

Timeliness of Services/Deliverables -Met interim milestones

-Reliable

-Responsive to technical direction

-Completed on time Business Relations -Effective management -Business like correspondence

-Responsive to contract requirements -Prompt notification of problems

-Reasonable/ cooperative

-Flexible

-Pro-active

are comprising the achievement of contract requirements Cost issues are comprising performance

do not impact achievement of contract requirements Cost issues do not impact achievement of contract requirements

The contractor has demonstrated an exceptional performance. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Exceptional".

The contractor has demonstrated an exceptional performance level. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

The contractor has demonstrated an exceptional performance level. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

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