36C25818Q0069-00002003.pdf

36C25818Q0069

Teleradiology

ATTACHMENT 8

Past Performance Questionnaire/Survey

Past Performance Questionnaire / Survey for: Tele-Radiology Services

OFFEROR’S NAME:

CONTRACT NUMBER:

CONTRACT TYPE:

CONTRACT DOLLAR VALUE:

BRIEF DESCRIPTION OF WORK:

DATE COMPLETED:

RATING(S):

“E” = Exceeds the standards.

“M” = Meets the standards.

“F” = Fails-please note the issue/problem/resolution.

PAST PERFORMANCE QUESTIONNAIRE / SURVEY QUESTIONS

Please rate and provide information/comments for the following: Please check one:

1. To what extent did the contractor comply with contract requirements? E M F

2. If reports were required, were they accurate in meeting contract requirements? E M F

3. To what extent did the contractor use appropriate personnel for contract E M F

Requirements.

4. To what extent did the contractor display technical expertise? E M F

5. To what extent was contractor able to meet the performance schedule? E M F

6. What extent was contractor flexible in responding to changing needs? E M F

7. To what extent was the contractor reliable? E M F

8. To what extent was the contractor responsive to technical directions? E M F

9. To what extent did contractor notify you of problems or potential problems? E M F

10. Have any cure notices, show cause letters, suspension of payment, or termination E M F been issued? If yes, please explain

11. Would you award another contract to the party being evaluated? If no, please E M F explain:

12. Was the customer satisfied with the end product? If not, please explain: E M F

36C25818Q0069

Teleradiology

NAME OF EVALUATOR:

SIGNATURE OF EVALUATOR: (Optional)

TITLE:

COMPANY:

TELEPHONE NUMBER:

EMAIL ADDRESS:

The completed Past Performance Questionnaire/Survey can only be submitted by the company/individual completing the response. Please return your completed Past Performance Questionnaire/Survey to either the mailing address provided below or facsimile at 520-629-1817 Attention: Danielle Sepulveda – (36C25818Q0069) or email to Lillian.Sepulveda@va.gov

Mailing address:

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRCTING OFFICE 22 GILBERT

Attn.: Danielle Sepulveda 9-90C (36C25818Q0069)

3601 S. 6th Ave.

Tucson, AZ 85723

NOTICE: All completed Past Performance Questionnaires / Survey to be received by 04/20/2018.

ADDITIONAL COMMENTS