36C78619Q0176-005.pdf

36C78619Q0176 Past Performance Evaluation Questionnaire 1

Date:

From:

To:

The Department of Veterans Affairs, National Cemetery Administration will be evaluating quotes for Florence National

Cemetery, National Shrine Project, under solicitation 36C78619Q0176. In accordance with Federal Acquisition

Regulations (FAR), the evaluation of our firm’s past performance will be included in the award evaluation decision to be made by VA. Your frank and candid response to this questionnaire will assist the evaluation team in this process.

We understand that you have a busy schedule and your participation in this survey is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible and submit no later than THE DATE AND TIME FOR RECEIPT OF

QUOTES WHICH IS CURRENTLY 8:00 A.M., MARCH 6, 2019. You are encouraged to provide comments on the lines provided after each question.

This survey should be completed by the individual most knowledgeable of our firm’s day-to-day operations and the overall condition of the service being rendered. However, that individual is encouraged to supplement their own knowledge of our performance with the judgment of others in your organization.

Completed evaluations shall be emailed directly to Max.Andrade@va.gov from evaluator.

If you have any questions regarding this document, please contact Mr. Max Andrade at 540-658-7221 or email

Max.Andrade@va.gov. Thank you for your valuable input and assistance.

mailto:Max.Andrade@va.gov

36C78619Q0176 Past Performance Evaluation Questionnaire 2

Contractor Name: __________________________________

Contractor Address: __________________________________

Contract Number: ____________________

Date of Award ______/______/_______

Original Contract Completion Date: ______/______/_______

Actual Contract Completion Date: ______/______/_______

Date Work Was Accepted by Owner: ______/______/_______

Description & Location of Work:

Contractor Rating: Please indicate the rating that best applies, and elaborate with comments where applicable. Please use the following criteria in your assessment:

Exceptional: Significantly exceeds contract requirements to benefit the owner. Performance in the area indicated was accomplished with few minor problems which were effectively corrected.

Very Good: Meets all contract requirements and exceeds some to benefit of the owner. Performance in the area indicated was accomplished with few minor problems which were effectively corrected.

Satisfactory: Meets all contract requirements. Performance in the area indicated was accomplished with some minor problems which appear to be adequately corrected.

Marginal: Does not meet some contractual requirements. Performance in the area indicated reflects a serious problem which has been minimally corrected, if at all.

Unsatisfactory: Does not meet contractual requirements and recovery is not likely in a timely or cost effective manner.

Performance in the area indicated contains serious problem(s) which have been ineffectively corrected.

Quality of Work

Did the contractor comply with all contract requirements? YES NO

Did the completed project meet your expectations? YES NO

How would you rate the contractor on the basis of owner (end-user) satisfaction?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Would you select this firm again? YES NO

Please Describe Contractor’s Strengths & Weaknesses (Use Additional Sheet if needed):

36C78619Q0176 Past Performance Evaluation Questionnaire 3

Technical Requirements

[1] Did the Contractor perform Headstone/Marker services under your requirement, to include [A] Realign, [B]

Raise/lower, [C] level, [D] backfill upright, and [E] Cleaning of headstones and markers? YES NO

How would you rate the contractor’s effectiveness on performing Headstone/Marker services?

[2] Did the Contractor perform [A] Demolishing and [B] Installing New Irrigation Systems/Lines under your requirement? YES NO

How would you rate the contractor’s effectiveness on performing the irrigation requirement?

[3] Did the Contractor perform Turf Renovation services under your requirement? YES NO

How would you rate the contractor’s effectiveness on performing Turf Renovation?

36C78619Q0176 Past Performance Evaluation Questionnaire 4

Overall Rating of Contractor

What is your overall rating of the contractor’s performance?

Thank you for your input. Please elaborate on your overall rating of this contractor.

Evaluated by:

Organization/Owner: _____________________________________________

Address: _____________________________________________

Name of Evaluator: _____________________________________________

Title of Evaluator: _____________________________________________

Signature : _____________________________________________

Date : ______/_______/_______

Telephone: ________________________ Fax: _________________

E-mail: ________________________