36C26119Q0206-002.pdf

Solicitation: 36C26119Q0206 DUE DATE: February 15, 2019

Attachment C - Past Performance Information Source Selection Sensitive FAR 3.104

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 by the due date to jason.hill@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 – Provide information about the Contract(s) that this vendor provided Transportation Services to your company. Identify the Contract #/ Delivery or Task Order #, Title, Location, Total Value of the contract and any other detail pertinent to this contract.)

Full Name of the Evaluator (Print):

Position held or function in relation to project:

Evaluator’s Company Name, Address and Phone number:

FAX Number:

Please complete and return to by the Due Date: jason.hill@va.gov

Past Performance Survey mailto:jason.hill@va.gov mailto:jason.hill@va.gov

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 Jason Hill, via email at Jason.hill@va.gov or mailing address Attn: Jason T. Hill, Department of Veterans Affairs, 150 Muir Road, Building AB736, Martinez, CA 94553-4668, no later than the due date: February 15,2019.

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 at appropriate length and detail any Transportation Services provided by this Contractor above and beyond normal service standards provided? Provide the dates of service.

Additional comments/remarks can be written on the last page of the survey.

mailto:Leala.Jew@va.gov

Rate the following questions if the company provided Transportation Services.

Provide information/comments in the Remarks Section below.

Circle One

Q1. To what extent did the contractor comply with contract requirements?

O A S M U

Q2. How timely was the contractor’s performance?

Q3. How well did the contractor comply with the labor and safety standards?

Q4. Rate the effectiveness of the contractor’s management of the contract?

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

Q6. Rate the contractor’s personnel management practices.

Q7. Quality Control: Rate the overall quality of contractor’s work.

T1. To what extent did the contractor meet performance schedule?

T2. What extent was contractor flexible in responding to changing needs?

T3. To what extent was the contractor reliable?

T4. To what extent was the Contractor responsive to technical directions?

T5. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, explain.

Yes No

C1. Would you award another contract to this contractor? If no, explain.

C2. Was the customer satisfied with the end product? If no, explain.

C3. To what extent did contractor notify you of problems of potential issues?

Past Performance Survey – Remarks Section

Evaluator’s Additional Remarks regarding Contractor’s performance providing Transportation Services.

Signature of Evaluator: Date of Evaluation:

Print Name of Evaluator:

Survey should be completed by the evaluator complete with signature and returned to Jason Hill, via email at Jason.hill@va.gov or mailing address Attn: Jason T. Hill, Department of Veterans Affairs, 150 Muir Road, Building AB736, Martinez, CA 94553-4668, no later than the due date: February 15, 2019.

Thank you for your time and due diligence.

Please do not send this to the Company you are evaluating.

This survey should be sent directly to Mr. Jason Hill.

mailto:Leala.Jew@va.gov