36C78618R0182-004.pdf

ATTACHMENT C Past Performance Questionnaire 36C78618R0182

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: john.carlock@va.gov no later than the three days after the solicitation closing date. NOTE: It is incumbent upon the offeror to have the customer send the completed questionnaire to the email address above by the submission date.

1. Contractor Name and Address (identify Division) 2. Contract No. 3. Contract Type:

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

Options) $

7. Period of Performance

1b. Address: 5. Customer Name / Evaluator: FROM:

1c. Point of Contact & Contact Information 6. Customer Point of Contact Information (email):

TO:

8. DESCRIPTION OF REQUIREMENT:

9. 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.

(a)

QUALITY

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

COMMENTS

(b)

PROBLEM

RESOLUTION

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

COMMENTS

(c)

COST

CONTROL

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

COMMENTS

(d)

TIMELINESS

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

COMMENTS

(e)

BUSINESS

RELATIONS

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

COMMENTS

(f)

CUSTOMER

SERVICE

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

COMMENTS

10. 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."

11. PRINTED NAME AND SIGNATURE OF EVALUATOR

11.a. EVALUATION DATE mailto:john.carlock@va.gov

RATING GUIDELINES

QUALITY OF PRODUCT OR SERVICES

0 Unsatisfactory Nonconformance jeopardizes the achievement of contract goals: default.

1 Poor

Nonconformance requires major agency intervention to ensure achievement of contract goals: show cause or cure notices 2 Fair

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

3 Good Quality meets specification in all cases.

4 Excellent Quality exceeds specifications in some cases.

PROBLEM RESOLUTION

0 Unsatisfactory Inadequately resolved problems jeopardize contract goals.

1 Poor Significant agency intervention required to resolve problems jeopardizing contract goals.

2 Fair Some agency intervention required to resolve problems jeopardizing contract goals.

3 Good

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

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

COST CONTROL

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

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

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

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

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

TIMELINESS OF PERFORMANCE

0 Unsatisfactory Delays jeopardize the achievement of contract goals.

1 Poor Significant delays.

2 Fair Minor delays.

3 Good All deliverables on time.

BUSINESS RELATION

0 Unsatisfactory Unethical or illegal business practices 1 Poor

Business practices are not attuned to customer support 2 Fair Business practices are somewhat attuned to customer support.

3 Good Business practices focus on customer support.

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

CUSTOMER SERVICE

0 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.

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

2 Fair

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

3 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.

4 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.