3a- PAST PERFORMANCE QUESTIONNAIRE.pdf
PDF 104 KB Posted
- Solicitation number
- 36C24826Q1106
About this file
This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate contractor performance on federal contracts.
The questionnaire collects performance ratings from past contract references across six key evaluation elements: Technical (Quality of Product or Service), Schedule, Cost Control, Business Relations, Management of Key Personnel, and Overall Rating. Each element is rated as either Satisfactory or Unsatisfactory by the reference providing the assessment. The form captures basic contract information including the contractor name, contract number, contract title, type of contract, and period of performance. References are required to provide detailed remarks supporting any unsatisfactory performance ratings, with space for continuation on separate sheets if needed. The questionnaire also includes a yes/no question regarding willingness to conduct future business with the offeror. Contact information for the source providing the evaluation is collected, including name, title, mailing address, telephone number, and date. The form is completed and signed by a VA employee, with designated spaces for the employee's name, title, date, and signature.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Name of offeror:
Contract Information:
Name of Contractor: Contract Number:
Contract Title:
Type of Contract: Period of Performance:
The ratings indicated below are to be supplied by the reference and not the offeror)
Performance Elements Satisfactor y Unsatisfacto ry
1. Technical (Quality of Product or Service)
(evaluation of the contractor’s technical performance or progress toward meeting requirements)
2. Schedule (evaluation of the timeliness of the contractor against milestones, delivery schedules)
3. Cost Control (evaluation of the contractor’s effectiveness in forecasting, managing, controlling cost and submitting accurate invoices)
4. Business Relations (assess the integration and coordination of all activity needed to execute the work, specifically the timeliness, completeness and quality of problem identification, corrective action, the contractor’s history of reasonable and cooperative behavior, customer satisfaction)
5. Management of Key Personnel (assess the contractor’s personnel performing the work)
6. Overall Rating
Remarks on unsatisfactory performance (Provide data supporting this observation. You may continue on separate sheet if needed.)
Would you do business with the offeror again?
Information provided by:
Name of Source:
Title:
Mailing Address:
City, State and Zip Code:
Telephone Number:
Date:
Questionnaire completed by:
Name of VA Employee:
Title:
Date: Signature:
File details come from the government source that posted it. Updated .