36C78618Q0148-004.pdf

ATTACHMENT - PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION: 36C78618Q0148

INSTRUCTIONS: -Offeror to complete boxes 1 through 7 before sending to past customer.

-Boxes 8 through 10 to be completed by past customer of Offeror and returned to: kenneth.dougherty@va.gov no later than three days after the solicitation closing date. NOTE: It is incumbent upon the offeror to have the customer send the completed questionnaire to email address above by the submission deadline.

1. Contractor Name, Address, Point of Contact: 2. Contract Number: 3. Contract Type:

1a. Name: 4. Contract Value (Current plus any unexercised

Options) : $

5. Period of Performance

1b. Address: 6. Customer Name / Evaluator’s: 5a. From:

1c. Point of Contact & Contact Information: 6a. Customer Point of Contact Information (email): 5b. To:

7. DESCRIPTION OF REQUIREMENT:

8. RATINGS - Summarize contractor performance and check the box corresponding to the performance rating for each category. See Rating Guidelines on subsequent pages for ratings categories and evaluation definitions.

QUALITY

1 [ ] Unsatisfactory 2 [ ] Marginal 3 [ ] Satisfactory 4 [ ] Very Good 5 [ ] Exceptional

COMMENTS

SCHEDULE

1 [ ] Unsatisfactory 2 [ ] Marginal 3 [ ] Satisfactory 4 [ ] Very Good 5 [ ] Exceptional

COMMENTS

MANAGEMENT

1 [ ] Unsatisfactory 2 [ ] Marginal 3 [ ] Satisfactory 4 [ ] Very Good 5 [ ] Exceptional

COMMENTS

REGULATORY

COMPLIANCE

1 [ ] Unsatisfactory 2 [ ] Marginal 3 [ ] Satisfactory 4 [ ] Very Good 5 [ ] Exceptional

COMMENTS

9. OVERALL RATING (select one of the below):

WOULD or WOULD NOT

“Given what I know today about the Contractor's ability to perform in accordance with the above contract or order's most significant requirements, I (would or would not) recommend them for similar requirements in the future."

10. PRINTED NAME AND SIGNATURE OF EVALUATOR: 10a. EVALUATION DATE: