D.8 ATTACHMENT 8 PAST PERFORMANCE SURVEY.36C26127Q0050.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C26127Q0050
About this file
This is a Past Performance Survey template for solicitation 36C26127Q0050, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21, for medical courier-delivery services of medication to residential and treatment facilities. The survey is designed to collect reference information from previous clients regarding an offeror's performance on past contracts.
The survey requires offerors to submit a separately completed and signed survey for each reference directly to durell.salaz@va.gov. Evaluators must provide the company name being evaluated, their own name and signature, company details with contact information, a description of services provided including performance dates, dollar amounts, and contract numbers. The evaluation section requests ratings on overall quality of work using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) with supporting comments, assessment of any performance issues and how they were resolved, and commentary on the contractor's overall performance and issue resolution capabilities. The form is a standard past performance reference document with no specific response deadlines, pricing terms, or set-asides noted within the template itself.
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Past Performance Survey 36C26127Q0050
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 .