36C26119Q0203-006.docx

D.2 PAST PERFORMANCE INFORMATION

OFFEROR INSTRUCTIONS: A separate record must be completed for each Past Performance Information and Survey; Offeror must directly send to the evaluator, requesting they complete and return as indicated on the attached Past Performance Survey, no later than, January 7, 2018 to durell.salaz@va.gov. Further, Offeror must include a copy of each requested Past Performance Information page with proposal submission.

Name of Offeror being evaluated:

Address of Offeror:

Contract Details (i.e. Contract #/ Delivery or Task Order #, Title, Location, etc)

Evaluator’s Full Name:

Evaluator’s Position held or function in relation to project:

Evaluator’s Company/Organization Name, Address and Phone number:

Evaluator’s email address:

Please complete and return to: durell.salaz@va.gov No later Than: 12:00 pm December 20, 2018 PST

Past Performance Survey

Reference Instructions: The Department of Veterans Affairs is considering the Offeror listed above for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (FAR) 15.506 prohibits the release of the names of the individuals providing reference information about the Offeror’s past performance. Survey should be completed by the evaluator and returned to durell.salaz@va.gov, no later than the above date.

Please evaluate the Past Performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, provide additional information in the appropriate block or in the remarks section of this form.

O = Outstanding = Performance greatly exceeded contract requirements

A = Above Average = Performance exceeded contract requirements

S = Satisfactory = Performance met contract requirements

M = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.

U = Unacceptable = Performance was poor and/or did not satisfy contract requirements

NOTE: Do not use a color marking pen to circle the response. Best to use a ball point pen (Black or Blue) to circle your response.

Describe exactly what types service(s) were provided to your company/organization?

Length of the Service (Provide dates):

Q5. Rate the contractor’s handling of staff integrity issues.

O A S M U

Q16. Was the contractor professional and courteous in its interaction with you?

Yes No

Q18. Did the contractor respond promptly to requests?

Yes No

Q19. Did the contractor meet all expectations under the contract?

Yes No

Past Performance Survey – Remarks Section Evaluator’s Additional Remarks regarding services:

Print Name of Evaluator:

Please email scanned copy directly to durell.salaz@va.gov Do NOT return survey to the company you are evaluating.

Source Selection Sensitive FAR 3.104 FOR OFFICIAL USE ONLY Source Selection Sensitive FAR 3.104 FOR OFFICIAL USE ONLY