D.7 ATTACHMENT 7 PAST PERFORMANCE SURVEY.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C26126Q0428
About this file
This is a Past Performance Survey template for the VA solicitation 36C26126Q0428 (J045--CFA Exhaust Fan Repair and Maintenance). The survey is designed to be completed by past clients or references of the offeror to evaluate the contractor's historical performance and capability. Completed surveys must be submitted directly to durell.salaz@va.gov, with a separate survey required for each reference provided by the offeror.
The survey requests evaluators to provide specific information about the contractor's work, including a summary of services performed, total contract amount, performance dates, and contract number. Evaluators are asked to rate the overall quality of work on a scale of Excellent, Good, Fair, Marginal, or Unacceptable, with supporting comments. Additionally, the survey inquires whether any performance issues or concerns arose during contract execution and how the contractor addressed them. The survey emphasizes that the names and identities of reference providers will remain confidential and will not be released publicly. This template is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26126Q0428 0001.docx | DOCX document | |
| RFQ 36C26126Q0428.Exhaust Hood.459.pdf | ||
| D.6 ATTACHMENT 6 DOL WAGE DETERMINATION 2015-5689 REV.27, DATED 12-03-2025 - HAWAII.SAMOA.pdf | ||
| D.4 ATTACHMENT 4 EXHAUST SPECIFICATIONS.pdf | ||
| D.5 ATTACHMENT 5 CFA EXHAUST LOCATIONS.pdf | ||
| D.2 ATTACHMENT 2 QUALITY ASSURANCE MONITORING FORM.docx | DOCX document | |
| 36C26126Q0428_1.docx | DOCX document | |
| D.3 ATTACHMENT 3 CONTRACT DISCREPANCY REPORT.docx | DOCX document | |
| D.1 ATTACHMENT 1 QUALITY ASSURANCE SURVEILLANCE PLAN.docx | DOCX document |
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Text version
Past Performance Survey 36C26126Q0428
OFFEROR INSTRUCTIONS: A separate survey must be completed and signed for each reference. The completed surveys must be submitted directly to durell.salaz@va.gov.
EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the company listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. The name of the individuals providing reference information is confidential and will not be released or made publicly available.
Please Note: When completing this Survey be sure to summarize what service(s) you provided on the contract(s) to include the performance dates, dollar amount(s) and contract number(s).
Name of Company being evaluated:
Evaluator’s Name and signature: Must be signed
Evaluator’s Company Name, Address and Phone number:
Indicate what services did this company provided for you? Provide the total contract amount, dates of performance, and contract number.
Evaluation Questions
Please rate the overall quality of work using a scale of (Excellent, Good, Fair, Marginal, Unacceptable). Comments in support of the rating are welcome.
Were there any performance issues/concerns? If so, how were they handled?
How did the Contractor perform on the contract?
Were there any issues and how did they handle them?
File details come from the government source that posted it. Updated .