Attachment 4 - Past Performance r1.docx
DOCX document 23 KB Posted
- Attached to
- Q517--Staffing Service Lancaster Federal contract opportunity
- Solicitation number
- 36C77022R0007
About this file
This document is a Past Performance Reference Contract form for a federal contract opportunity. The form is to be completed by a reference contact for a prime contractor who has submitted a proposal for Solicitation Number 36C77022R0007 to provide Pharmacist/Pharmacy Technician and Shipper/Packer staffing services for the Lancaster Consolidated Mail Outpatient Pharmacy Facility.
The reference contact is asked to provide information about the contractor's past performance, including their ability to provide experienced managers, maintain sufficient qualified personnel, fill staff vacancies, solve problems, and manage the onboarding process. The reference is also asked to provide an overall performance rating on a scale of 0 to 5 and indicate whether they would award another contract to the contractor. The reference must certify that the information provided is accurate.
View the file
Other files for this federal contract opportunity
Show all 31
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 6 – Past Performance INSTRUCTIONS TO PRIME CONTRACTOR: (Contractor submitting proposal):
Complete the CONTRACTOR INFORMATION section. 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 |
| 36C77022R0007 |
| Description of Work |
| Pharmacist/Pharmacy Technician and Shipper/Packer Staffing for the Lancaster 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
Number of FTEE YOUR FIRM provided
PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’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 Contractor … |
| 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: |
| |_| 0 |
| |_| 1 |
| |_| 2 |
| |_| 3 |
| |_| 4 |
| |_| 5 |
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 .