36C78618R0097-004.pdf

PAST PERFORMANCE QUESTIONNAIRE - 36C7861R0097

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: Send to: Ann.Manning@va.gov if not submitted with offer, no later than the date provided by the solicitation. 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: 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 second page for rating descriptions.

8a.

QUALITY

1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

8b.

SCHEDULE/

DELIVERY

1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

8c.

PROBLEM

RESOLUTION

1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

8d. 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

8e.

1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

8f. 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ]

COMMENTS

9. OVERALL RATING:

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

RATING GUIDELINES

QUALITY OF PRODUCT OR SERVICES

1 Unsatisfactory

Nonconformance jeopardizes the achievement of contract goals: default.

2 Poor

Nonconformance requires major agency intervention to ensure achievement of contract goals: show cause or cure notices cemManniA Typewritten Text

3 Fair Quality meets specifications in most cases, however, some agency intervention required to ensure achievement of contract requirements.

4 Good Quality meets specification in all cases.

5 Excellent Quality exceeds specifications in some cases.

PROBLEM RESOLUTION

1 Unsatisfactory

Inadequately resolved problems jeopardize contract goals.

2 Poor

Significant agency intervention required to resolve problems jeopardizing contract goals.

3 Fair

Some agency intervention required to resolve problems jeopardizing contract goals.

4 Good

Successfully overcomes or resolves all problems and achieves contract goals with minimal agency intervention.

5 Excellent

Anticipates and avoids most problems and successfully overcomes all unforseen problems.

RESERVED

Unsatisfactory Cost increases jeopardize achievement of contract goals: or billings routinely include unallowable costs.

2 Poor Significant cost increases; or some inaccurate billings including some with unallowable costs.

3 Fair Minor cost increases; or some inaccurate billings, but a minimal (1-2) number of unallowable cost.

4 Good Contractor performed within cost; but some late billings, none with unallowable costs.

5 Excellent Costs were less than the amount cited in the contract; and billings accurate and timely.

RESERVED

1 Unsatisfactory

Delays jeopardize the achievement of contract goals.

2 Poor

Significant delays.

3 Fair

Minor delays.

4 Good

All deliverables on time.

5. Excellent ON

1 Unsatisfactory Unethical or illegal business practices

2 Poor Business practices are not attuned to customer support

3 Fair Business practices are somewhat attuned to customer support.

4 Good Business practices focus on customer support.

5 Excellent Highly effective, proactive business practices focused on customer support.

RESERVED

1 Unsatisfactory Response to service requests is routinely late, ineffective or rude; customers express frustration or anger about many interactions; complaints are unresolved;

contractor seems unaware of service issues.

2 Poor Response to service requests is often late, ineffective or rude; some complains are resolved.

3 Fair Response to service requests is uneven in timing or effectiveness; customer interactions are tenuous; contractor is trying hard and understands services issues.

4 Good Response to service requests is timely, effective and courteous; customers express positive feedback; delivery of service is smooth and organized; collects customer feedback; customer problems are resolved well.

5 Excellent Response to service requests is timely, effective and courteous; the contractor is proactive in building good relations with customers, proposing new service strategies, analyzing and reporting on service loads and collecting and using customer feedback.

SOLICITATION: VA786-15-R-0042