36C25818Q0009-014.docx

CONTRACTOR TECHNICAL AND PAST-PERFORMANCE QUESTIONNAIRE

The contractor has provided a proposal for solicitation 36C25818Q0009 Linen Transportation Services for the Phoenix, Tucson, and Prescott VA Medical Centers.

A primary consideration in our selection process is the contractor’s history of performance of similar services. Please make every effort to be as thorough as possible in your answers/comments.

Please refer any questions to: Arcelia Medina P: 520-792-14550 x: 4313 E: Arcelia.medina@va.gov. All responses can be sent directly to this email address or provided to the contractor that is asking for the information.

A. GENERAL INFORMATION

Contractor’s Name: ____________________________________________________________ Address: _____________________________________________________________________ Telephone Number: _____________________ Point of Contact: ________________________

B. RESPONDENT INFORMATION

Name: _______________________________ Title: ________________________________ Organization & Address: ________________________________________________________ Telephone: __________________ Fax: ________________ Email: _____________________

C. CONTRACT INFORMATION

Contract Number/Title: __________________________________________________________ Period of Performance: ________________ Dollar Amount of Contract: __________________ Services Performed: ____________________________________________________________

D. PERFORMANCE INFORMATION

Choose the category on the below scale that most accurately describes the contractor’s performance or situation.

5 - NEUTRAL - No past performance available for evaluation. Offeror has asserted that it has no directly related or similar relevant past performance experience. Proposal receives no merit or demerit for this factor.

4 - OUTSTANDING - Based on the Offeror’s record of past performance, no issues, concerns, or risks are associated with receiving timely services and contract performance. Past performance surveys and the Offeror’s experiences indicate that the Offeror is capable of exceeding the PWS and contract requirements. The Contractor has demonstrated significant experience with and knowledge of the issues and problems of large organizations.

3 – GOOD - The Offeror’s record of past performance indicates there is very little risk associated with receiving quality, timely services and full contract performance. Past performance surveys and the Offeror’s experience indicate the Offeror will meet or exceed the requirements of contract PWS. The Contractor has demonstrated experience with and knowledge of the issues and problems of large organizations.

2 - ACCEPTABLE- The Offer’s record of past performance indicates that there is some potential risk associated with receiving quality, timely services, and contract performance. Past performance surveys and the Offeror’s experience indicate the Offeror may have some problems during performance. The Contractor has demonstrated limited experience and knowledge of the issues and problems of large organizations.

1 – UNSATISFACTORY - The Offeror’s record of past performance indicates it will be unable to perform successfully.

Please use the above ratings to describe the contractor’s performance in the following areas:

Management Effectiveness

COMMENTS/REMARKS:___________________________________________________________________________________________________________________________________________________ Quality Assurance

Quality Assurance and Success of Quality Control

1 2 3 4 5

COMMENTS/REMARKS:___________________________________________________________________________________________________________________________________________________

Compliance with Environmental/Labor/Safety Requirements

E. If this was a government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? __________ If yes, please describe:

F. If given the opportunity, would you award another contract to this contractor? Please explain response below.