D. 3 PAST PERFORMANCE QUESTIONNAIRE.pdf

LOWER PROSTHETICS 36S79723R0001

PAST PERFORMANCE QUESTIONNAIRE

The following Offeror has submitted a proposal for Solicitation # 36S79723R0001 Lower Prosthetics and has referenced your company in their past performance. Please provide information on the past performance of the offeror under evaluation by completing this document and returning to the Contracting team.

Solicitation Number Offeror under Evaluation Name

Submit document by email to: Michelle Williams, michelle.williams4@va.gov Brandy Hudson brandy.hudson@va.gov

Subject Line should read as: Solicitation #, Past Performance Questionnaire Describe the nature of your contract with the referenced Vendor (If more space is needed, please use the (“Additional Comments” block on the second page)

Company/Organization Providing Reference

Company Representative Completing Questionnaire

Company Representative Email Company Representative Phone Number

Contract Description the Offeror was Awarded

Contract Number or Project ID Period of Performance Contract Award Amount What was the role of Offeror? Prime or Subcontractor?

Complete the following questions, by marking the adjectival ratings and providing comments in which there was significant discrepancies or excellent performance.

PLEASE NOTE: In accordance with Federal Acquisition Regulations, contractors may be advised of adverse remarks and given an opportunity to respond. However, the contracting officer will not provide your name or copies of this questionnaire to the contractor or any other party not directly involved in the evaluation of the contractor’s proposal.

ADJECTIVAL RATINGS DEFINITIONS

“E” Excellent: Performance meets contractual requirements and exceeds the Government’s expectations. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

(HIGH CONFIDENCE)

“VS” Very Good: Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. (SIGNIFICANT CONFIDENCE)

“S” Satisfactory: Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective action taken by the contractor appear or were satisfactory. (CONFIDENCE) mailto:michelle.williams4@va.gov mailto:brandy.hudson@va.gov

“M” Marginal: Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. (LITTLE CONFIDENCE)

“U” Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective. (NO

CONFIDENCE)

“N” Neutral: No relevant past performance record is identifiable upon which to base a meaningful performance risk prediction. A search was unable to identify any relevant past performance information for the contractor or their key personnel. (This is neither a negative nor positive assessment.).

PAST PERFORMANCE ADJECTIVAL RATINGS

1. How well were the contract requirements met in compliance with contractual terms and conditions?

E VS S M U N

Compliance of technical data/report preparation terms?

Comments:

2. To what extent did the contractor adhere to the E VS S M U N Performance schedule? Quality Control?

Comments:

3. How responsive was the contractor in resolving E VS S M U N quality, schedule, or other contract issues?

Comments:

4. How effective was the contractor in addressing E VS S M U N unforeseen or unusual customer needs and issues?

Comments:

5. How well was the contractor in ability to meet quality

E VS S M U N

standards for technical performance?

Comments:

6a. If you represent a government agency, and the contract included a small business subcontracting plan, how well did the contractor adhere to the plan requirements?

E VS S M U N

6b. If you represent a government agency, and the contract included a small business subcontracting plan, how was performance against subcontract goals?

E VS S M U N

6c. If you represent a government agency, and the contract included a small business subcontracting plan, how was compliance with subcontracting plan in general?

E VS S M U N

6d. If you represent a government agency, and the contract included a small business subcontracting plan, was there timely eSRS reporting?

E VS S M U N

Comments:

7. How satisfied were you with the contractor’s overall

E VS S M U N

performance?

Comments:

Additional Comments:

Additional Comments Continued:

Thank you for your response.