Attachment 5 - Past Performance r2.pdf
PDF 174 KB Posted
- Attached to
- Q517--Staffing Service Hines Federal contract opportunity
- Solicitation number
- 36C77022R0006
About this file
This document is a Past Performance form for a federal contract opportunity. It instructs offerors to provide information about their company's past performance, including the name of the government agency or company that served as the reference, the contract number, whether the offeror was the prime or subcontractor, the dollar value and period of performance, and a description of the services provided. The reference contact is then asked to evaluate the offeror's performance on a scale of 0 to 5 across 18 criteria, such as providing experienced managers, maintaining staffing levels, and responsiveness to contract changes. The reference is also asked whether they would award another contract to the offeror. The federal contract opportunity associated with this Past Performance form is a solicitation for Pharmacist/Pharmacy Technician and Shipper/Packer Staffing services for the Hines Consolidated Mail Outpatient Pharmacy Facility, issued by the Department of Veterans Affairs Veterans Health Administration.
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Text version
Attachment 5 – Past Performance
INSTRUCTIONS TO OFFERORS:
Enter the information in the section below for the entity being evaluated by the past performance Reference Contact. In addition, enter your name and address in the blank included in the Instructions to Reference Contact.
Save the document. Send an electronic or hard copy print of the form to each of your Reference Contacts, asking them to please complete the form and submit it according to the instructions, below.
Company Name Street Address
Point of Contact City
Point of Contact Phone Number State E-Mail Address Zip Code Solicitation Number 36C77022R0006
Description of Work Pharmacist/Pharmacy Technician and Shipper/Packer Staffing for the Hines Consolidated Mail Outpatient Pharmacy Facility.
INSTRUCTIONS TO REFERENCE CONTACT
Please complete the following pages as a past performance Reference Contract for the entity named above. Once completed, please return the form to: Nicholas Schulte, Nicholas.Schulte1@va.gov.
RESPONDENT INFORMATION [completed by Reference Contact]
Government Agency or Company name Street Address
POC Name City
Phone Number State
Fax Number Zip Code
Contract Number
Prime or Subcontractor
Dollar Value
Period of Performance
Description of services provided
Location of services provided
PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the vendor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below (text box will expand to whatever extent is necessary).
0 1 2 3 4 5
NEUTRAL UNSATISFACTORY MARGINAL SATISFACTORY GOOD EXCEPTIONAL
No record of past performance or the record is incon-clusive.
Performance did not meet most contractual require-ments. There were serious problems and the contractor’s corrective actions were ineffective.
Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.
Performance met most contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.
Performance met all contract requirements and exceeded some.
There were a few minor problems, which the contractor resolved in a timely, effective manner.
Performance exceeded all contract requirements. There were no problems.
The Vendor … 0 1 2 3 4 5
1. Provided experienced managers and/or supervisors with the technical and administrative abilities needed to meet contract requirements.
2. Demonstrated ability to hire, maintain, and replace, if necessary, sufficient qualified personnel throughout the contract period.
3. Ability to fill staff vacancy in a timely manner.
4. Home office participated in solving significant local problems as necessary.
5. Had sufficient personnel to monitor, support and provide oversight for large numbers of staff at geographically dispersed locations.
6. Provided highly qualified personnel throughout the life of the contract.
7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.
8. Provided timely resolution of contract discrepancies
9. Identified problems as they occurred.
10. Suggested alternative approaches to problems.
11. Displayed initiative to solve problems.
12. Managed on-boarding and background investigation process efficiently and timely.
13. Was responsive to contract changes.
14. Maintained consistent staffing levels for positions in cases of call outs, illnesses, injuries, etc.
15. Cooperated with Company/ Government personnel after award.
16. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
YES NO
17. Would you award another contract to this contractor? If not, please explain in “remarks.”
YES NO
18. OVERALL PERFORMANCE RATING:
REMARKS (Please use as much space as is needed – the box will expand as you type).
I hereby certify that the information that I have reported above is accurate to the best of my knowledge.
Printed Name
E-mail address
Business Title Signature Date
File details come from the government source that posted it. Updated .