Attachment 2 Past Performance Questionaire.docx
DOCX document 23 KB Posted
- Attached to
- 3650--GL-CMOP (TCA) w-Auto-Packer Federal contract opportunity
- Solicitation number
- 36C77024R0011
About this file
This document is a Past Performance Questionnaire that is part of the solicitation requirements for a federal contract opportunity. The key details are:
The contract opportunity is for Pharmacist/Pharmacy Technician and Shipper/Packer Staffing for the Murfreesboro Consolidated Mail Outpatient Pharmacy Facility, with a Solicitation Number of 36C77022R0003. The contracting agency is the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 15. The questionnaire asks the reference contact to evaluate the past performance of the prime contractor across 18 performance criteria on a scale of 0 (Neutral) to 5 (Exceptional), and provide an overall performance rating. The reference is also asked whether the contractor was issued a cure or show cause notice, and whether they would award another contract to the contractor. The completed questionnaire is to be returned directly to the agency point of contact, Larry Zaritz.
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Text version
Attachment 5 – Past Performance INSTRUCTIONS TO PRIME CONTRACTOR: (Contractor submitting proposal):
Complete the CONTRACTOR INFORMATION section. Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.
Company Name
Street Address
Point of Contact
City
Point of Contact Phone Number
State
E-Mail Address
Zip Code
| Solicitation Number |
| 36C77022R0003 |
| Description of Work |
| Pharmacist/Pharmacy Technician and Shipper/Packer Staffing for the Murfreesboro Consolidated Mail Outpatient Pharmacy Facility. |
INSTRUCTIONS TO REFERENCE CONTACT
Please complete the following pages as a past performance Reference Contract for the entity named above. Once completed, please return the form to: Larry Zaritz, larry.zaritz@va.gov.
RESPONDENT INFORMATION [completed by Reference Contact]
Government Agency or Company name
Street Address
POC Name
City
Phone Number
State
Fax Number
Zip Code
Contract Number
Prime or Subcontractor
Dollar Value
Period of Performance
Description of services provided
Location of services provided
Number of FTEE YOUR FIRM provided
PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below (text box will expand to whatever extent is necessary).
| 0 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| NEUTRAL |
| UNSATISFACTORY |
| MARGINAL |
| SATISFACTORY |
| GOOD |
| EXCEPTIONAL |
| No record of past performance or the record is incon-clusive. |
| Performance did not meet most contractual require-ments. There were serious problems and the contractor’s corrective actions were ineffective. |
| Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective. |
| Performance met most contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. |
| Performance met all contract requirements and exceeded some. There were a few minor problems, which the contractor resolved in a timely, effective manner. |
| Performance exceeded all contract requirements. There were no problems. |
| The Contractor … |
| 0 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 1. |
| Provided experienced managers and/or supervisors with the technical and administrative abilities needed to meet contract requirements. |
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| 2. |
| Demonstrated ability to hire, maintain, and replace, if necessary, sufficient qualified personnel throughout the contract period. |
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| 3. |
| Ability to fill staff vacancy in a timely manner. |
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| 4. |
| Home office participated in solving significant local problems as necessary. |
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| 5. |
| Had sufficient personnel to monitor, support and provide oversight for large numbers of staff at geographically dispersed locations. |
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| 6. |
| Provided highly qualified personnel throughout the life of the contract. |
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| 7. |
| Corrected deficiencies in timely manner and pursuant to their quality control procedures. |
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| 8. |
| Provided timely resolution of contract discrepancies |
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| 9. |
| Identified problems as they occurred. |
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| 10. |
| Suggested alternative approaches to problems. |
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| 11. |
| Displayed initiative to solve problems. |
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| 12. |
| Managed on-boarding and background investigation process efficiently and timely. |
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| 13. |
| Was responsive to contract changes. |
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| 14. |
| Maintained consistent staffing levels for positions in cases of call outs, illnesses, injuries, etc. |
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| 15. |
| Cooperated with Company/ Government personnel after award. |
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| 16. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
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| YES |
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| NO |
| 17. |
| Would you award another contract to this contractor? If not, please explain in “remarks.” |
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| YES |
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| NO |
| 18. |
| OVERALL PERFORMANCE RATING: |
| |_| 0 |
| |_| 1 |
| |_| 2 |
| |_| 3 |
| |_| 4 |
| |_| 5 |
REMARKS (Please use as much space as is needed – the box will expand as you type).
I hereby certify that the information that I have reported above is accurate to the best of my knowledge.
Printed Name
E-mail address
Business Title
Signature
Date
File details come from the government source that posted it. Updated .