Attachment 1 Past Performance Questionaire.pdf

Attachment 2 36C24820R0069

PAST PERFORMANCE QUESTIONNAIRE

Request for Proposal: 36C24820R0069

North Florida/South Georgia VA Medical Center Home Oxygen

Message to the assessor: Your assistance is requested by Scott Brickey, the Contract Specialist to assist with establishing the performance history. In efforts to expedite receipt of the requested information, the

Contract Specialist respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to: scott.brickey@va.gov. If not, enough space is provided, please attach additional information to this questionnaire.

1. Name of Home Oxygen Contractor: _______________________________________________________

Contract or Identifying Number:

Title/Description of Contract:

Based upon the definitions below, indicate your assessment of the contractor’s performance. Your assessment should consider the contractor’s performance in accordance with the contractual requirements.

Please include the period of performance and contract value:

2. Brief description of scope of work:

EVALUATION: Please rate the Contractor using the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Assessment Definition

EXCEPTIONAL (EX) Performance EXCEEDS MOST contractual requirements to the Government’s benefit. The performance of areas being assessed was accomplished with few minor issues or concerns.

VERY GOOD (VG) Performance EXCEEDS SOME contractual requirements to the Government’s benefit. The performance of areas being assessed was accomplished with few minor issues or concerns, for which the Contractor’s corrective actions were highly effective

SATISFACTORY (S) Performance MEETS contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the Contractor were effective.

MARGINAL (M) Performance MEETS SOME contractual requirements. The performance of the areas being assessed includes significant problems, issues, or concerns for which corrective actions taken by the Contractor were only somewhat effective.

UNSATISFACTORY

(UN)

Performance DOES NOT MEET contractual requirement. The performance of the areas being assessed includes serious problems, issues, or concerns for which the Contractor’s corrective actions were ineffective.

Performance was completed in a timely manner per the Terms and Conditions. EX VG S M UN

Compliance with contractual Terms and Conditions. EX VG S M UN

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

EX VG S M UN

Provided effective quality control and/or inspection procedures to meet contract requirements.

EX VG S M UN

Corrected deficiencies in timely manner and pursuant to the contractor’s quality control procedures.

EX VG S M UN

Exhibited knowledge of and compliance with Government (or other) regulations and industry standards.

EX VG S M UN

How effective was the contractor in responding to emergency calls in a timely manner?

EX VG S M UN

To what extent was the contractor able to solve contract performance problems without extensive guidance from procurement or technical personnel?

EX VG S M UN

Provides timely and accurate documents, records, and invoices as required by the contract.

EX VG S M UN

Would you award similar contracts to this contractor? Please provide explanation for response.

EX VG S M UN

Rate the Contractor’s OVERALL quality of performance under this contract EX VG S M UN

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in Additional Comments.

YES NO

Would you award another contract to this contractor? If not, explain Additional

Comments.

YES NO

EXPLANATION OF OVERALL RATING GIVEN:

Name & Signature of Assessor’s:

Company/Agency: ________________________________________ Date: