ATTACHMENT 1 PAST PERFORMANCE QUESTIONAIRE RFP 36C24826R0121.docx
DOCX document 23 KB Posted
- Attached to
- V231--FY26: Self-Care Housing (HAS) AMENDMENT 0002 Federal contract opportunity
- Solicitation number
- 36C24826R0121
About this file
This is a Past Performance Questionnaire template for RFP 36C24826R0121, a Self-Care Housing Services solicitation issued by the Department of Veterans Affairs Network Contracting Office 8 for the James A. Haley VA Hospital. The questionnaire is to be completed by the offeror's previous clients and returned directly to Kim Tucker at Kim.Tucker1@va.gov. Offerors are responsible for ensuring accurate and verifiable point of contact information for their references, as incorrect or unverifiable information may result in lower past performance ratings.
The questionnaire evaluates contractor performance across 16 key evaluation criteria using a five-point adjectival rating scale (Excellent, Good, Satisfactory, Marginal, Poor, or No Rating). Evaluation areas include ability to meet quality standards, compliance with contractual terms, quality of technical data and reports, quality control effectiveness, contract management and on-site management capabilities, contractor cooperation and responsiveness, problem resolution timeliness, emergency response capability, material management, innovation in cost reduction and improvement, safety record and responsiveness, invoice accuracy and timeliness, workforce hiring and retention, contract termination history, and financial stability. The questionnaire also captures information regarding whether the contract was competitive, the contractor's role (prime or subcontractor), and includes fields for evaluator contact information and comments.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24826D0050_1.docx | DOCX document | |
| AMENDMENT 0002 RFP 36C24826R0121 7.21.26.docx | DOCX document | |
| 36C24826R0121 0002_2.docx | DOCX document | |
| 36C24826R0121 0001_1.docx | DOCX document | |
| AMENDMENT 0001 RFP 36C24826R0121 07.14.2026.docx | DOCX document | |
| Combined Synopsis Description RFP 36C24826R0121.docx | DOCX document | |
| 36C24826R0121_1.docx | DOCX document | |
| RFP Self Care Housing 36C24826R0121.docx | DOCX document |
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Text version
ATTACHMENT 1
PAST PERFORMANCE QUESTIONNAIRE COVER SHEET
PAST PERFORMANCE QUESTIONNAIRE
SOLICITATION RFP #36C24826R0121
SELF CARE HOUSING SERVICE
The entire questionnaire should be forwarded to your previous clients for completion and clients shall directly return the cover sheet and questionnaire to Kim Tucker at e-mail address: Kim.Tucker1@va.gov It is your responsibility to ensure correct and verifiable point of contact information. Information that is incorrect or unverifiable may lead to a lower past performance rating.
(Offeror Fill-In Below)
1. Offeror Name (Name of Organization/Firm being Evaluated):
2. Name of Organization/Firm Providing Reference:
3. Address of Organization/Firm Providing Reference:
4. Contract Number:
5. Project Description:
6. Contract/Task Order Amount:
7. Performance Period:
PAST PERFORMANCE QUESTIONNAIRE
SOLICITATION RFP #36C24826R0121
ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE
| E (EXCELLENT) |
| Performance meets contractual requirements and exceeds expectations. The contractual performance of the element assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. (High Confidence). |
| G (GOOD) |
| Performance meets contractual requirements and exceeds some requirements. 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 elements contains some minor problems for which corrective action taken by the contractor is satisfactory. (Confidence). |
| 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). |
| P (POOR) |
| Performance does not meet most contractual requirements and recovery is no likely in a timely manner. The contractual performance of the element contains serious problems for which the contractor’s corrective actions appear or were ineffective. (No confidence). |
| NR (NO RATING) |
| 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 or positive assessment). |
EVALUATOR: PLEASE CIRCLE THE ADJECTIVAL RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE
| Was this a competitive contract? |
| YES NO |
| Role of the contractor |
| Prime Contractor or Subcontractor |
| Ability to meet quality standards specified for technical performance |
| E G S M P NR |
| Compliance with contractual terms and conditions |
| E G S M P NR |
| Quality/integrity of technical data/report preparation efforts. |
| E G S M P NR |
| Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirement. |
| E G S M P NR |
| Effectiveness of overall contract management (including ability to effectively lead, manage, and control the project.) |
| E G S M P NR |
| Effectiveness of on-site management and control of multidiscipline construction categories, including management of subcontractors. |
| E G S M P NR |
| Contractor was reasonable and cooperative in dealing with staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports). |
| E G S M P NR |
| Timeliness/effectiveness of contract problem resolution without extensive customer guidance. |
| E G S M P NR |
| Ability to successfully respond to emergency situations. |
| E G S M P NR |
| Effectiveness of material management. |
| E G S M P NR |
| Contractor proposed innovative alternative methods that reduced cost, improved maintainability or other factors that benefited the client. |
| E G S M P NR |
| Contractor Safety Record. |
| E G S M P NR |
| Contractor responsiveness to safety issues. |
| E G S M P NR |
| Contractor’s timeliness, completeness, and accuracy in submitting invoices. |
| E G S M P NR |
| Ability to hire and retain a qualified workforce to this effort. |
| E G S M P NR |
If this was a Government contract has the contract been terminated for default or Convenience? Indicate if show cause or cure notices were issued or any default action in the comment section below.
E G S M P NR
| Have there been any indications that the contractor has had any financial problem? |
| E G S M P NR |
COMMENTS:
EVALUATOR’S POINT OF CONTACT INFORMATION:
SIGNATURE: ____________________________________________________
EVALUATOR NAME: _______________________________________________
EVALUATOR TITLE: ________________________________________________
E-MAIL ADDRESS: ___________________________________________________
PHONE NUMBER: ___________________________________________________
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