36C78619Q0191-002.docx

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FY19 NATIONAL SHRINE PROJECT - NORTH ATLANTIC DISTRICT. Bath National Cemetery - Raise/Reset/Realign & Clean Upright Headstones, Install French Drain and Renovate Turf with Sod - Section L. Contractor shall furnish all equipment, parts
Solicitation number
36C78619Q0191
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36C78619Q0191 Attachment B Past Performance Questionaire.docx

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ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION: 36C78619Q0191

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: Paul.Zagaruyka@va.gov no later than three days before the solicitation closing date provided in the RFQ. 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. 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."

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

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