Attachment 11 - Past Performance Questionnaire.docx
DOCX document 23 KB Posted
- Attached to
- R408--FY24 IVC PHARMACY BENEFIT MANAGER
- Solicitation number
- 36C79123R0007
About this file
This document contains a past performance questionnaire template for evaluation of offerors for solicitation number 36C79123R0007 for pharmacy benefit manager services from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19. The past performance questionnaire requests information about the offeror's performance on a prior contract, including quality of work, adherence to schedule, responsiveness in resolving issues, effectiveness in addressing customer needs, and overall contract performance. Respondents are asked to provide an evaluation rating and comments for each question. Completed questionnaires must be returned by email to the contracting officer and contract specialist at the Department of Veterans Affairs by August 25, 2023.
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SOURCE SELECTION SENSITIVE See FAR 2.101 and 3.104 (upon completion) Attachment 11 – Past Performance Questionnaire (Pharmacy Benefit Management Services) Solicitation 36C79123R0007
Contractor Name: ________________________ Role on Project: ________________________________
Contractor Address: ____________________________________________________________________
Contract Number: _________________________ Contract Type: ________________________________
Dollar Amount of Award: $__________________ Annual Amount: $_____________________________
Client Name/Title of Person Completing Questionnaire: _______________________________________
Client Phone/Email of Person Completing Questionnaire: _____________________________________
Client Company/Organization: ____________________________________________________________
Briefly describe the scope of work and size in dollars of your contract with the Offeror, including a description of the services provided and the period of performance. (If more space is needed, please use the “Additional Comments” block on the last page.)
Please return this Past Performance Questionnaire by email to: Department of Veterans Affairs, Commodities and Services Acquisition Service (CSAS) Attn: Contracting Officer sandra.mcanany@va.gov and Contract Specialist: Joanna.hudson-lundquist@va.gov no later than 8/25/2023
EVALUATION RATING DEFINITIONS (see FAR subpart 42.1503, Table 42-1)
| Exceptional |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory |
| Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. |
| Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
Past Performance Question
Evaluation Rating
1. Describe the quality of work performed by the contractor and what was the performance.
Comments:
2. Describe the extent to which the contractor adhered to the schedule.
3. How responsive was the contractor in resolving quality, schedule, or other contract issues?
4. How effective was the contractor in addressing specific customer needs?
5. How satisfied were you with the contractor’s overall contract performance?
6. Would you award another contract to this contractor?
ADDITIONAL COMMENTS:
PLEASE NOTE: In accordance with Federal Acquisition Regulation (FAR) subpart 15.306 Exchanges with offerors after receipt of proposals, offerors may be given the opportunity to clarify adverse past performance information if awarding without discussions and the offeror has not previously had an opportunity to respond; or if past performance information is the determining factor preventing the offeror from being placed within the competitive range and the offeror has not previously had an opportunity to comment. 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.
FOR OFFICIAL USE ONLY Page 2 of 2 Solicitation Number 36C79123R0007 Attachment 11
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