D.5_-_Past_Performance_Questionnaire.pdf

Respondent Information (to be completed by respondent) Respondent

Company/Organization Name and Address:

Respondent Point of Contact: ___________________________________________

Phone number: ___________________________________________

The following scale provides the definitions for the Past Performance ratings to be assessed:

Exceptional

Based on the Offeror's performance record, essentially no doubt exists the Offeror will successfully perform the required effort. Past performance has met contractual requirements and has exceeded some to the respondent's benefit. Contractual performance was accomplished with few minor problems for which corrective action(s) taken by the contractor were highly effective.

Very Good

Based on the Offeror's performance record, little doubt exists the Offeror will successfully perform the required effort. Past performance has met contractual requirements and has exceeded some to the respondent's benefit.

Contractual performance was accomplished with some minor problem(s) for which corrective action(s) taken by the contractor were effective.

Satisfactory

Based on the Offeror's performance record, some doubt exists the Offeror will successfully perform the required effort. Past performance has met contractual requirements. Contractual performance contains some minor problem(s) for which corrective action(s) taken by the contractor appear or were satisfactory.

Marginal

Based on Offeror's performance record, substantial doubt exists the Offeror will successfully perform the required effort. Past performance has not met some contractual requirements. Contractual performance reflects a serious problem for which either the contractor has not yet identified correction action(s), or the proposed corrective action(s) appear marginally effective.

Unsatisfactory

Based on Offeror's performance record, extreme doubt exists the Offeror will successfully perform the required effort. Past performance has not met most contractual requirements, and recovery did not occur or was not in a timely manner. Contractual performance contains serious problem(s) for which the contractor's corrective action(s) were ineffective.

Neutral No performance record identifiable; unknown performance.

Using the ratings scale, please complete the questionnaire. Use the drop down menus to provide answers. Supplement your answers with explanations in the comment space provided.

QUALITY OF SERVICE

1. Rate the contractor’s compliance with contractual requirements:

2. Overall rating of contractor quality of service:

COMMENTS:

SCHEDULE

1. Requirements were completed within required time period:

2. Overall rating of contractor ability to complete schedule:

COMMENTS:

Please return the completed questionnaire to Daniel Reinke at daniel.reinke@va.gov

BUSINESS RELATIONS

1. Rate the working relationship between contractor’s management, your company, and other representatives (to include inspection personnel).

2. Rate the contractor’s ability to submit complete and accurate reports and/or invoices.

3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner.

4. Rate the contractor’s responsiveness to customer complaint resolution.

5. Overall rating of contractor’s business relations.

COMMENTS:

How would you feel about awarding another contract to this contractor? (choose one)

__ Would not hesitate to award another contract to this contractor.

__ Would most likely award another contract to this contractor.

__ Would think twice about awarding another contract to this contractor, but would do so if no better alternative existed.

__ Do not wish to award another contract to this contractor.

__ Would not award another contract to this contractor.

COMMENTS:

(Signature) (Date)

(Printed Name and Title)