Attachment 2 - Past Performance Survey.docx
DOCX document 35 KB Posted
- Attached to
- Commercial Plumbing Services for the VA Pacific Islands Health Care Systems IAW the Statement of Work.
- Solicitation number
- 36C261-26Q0516
About this file
This is a past performance survey template designed to collect reference feedback on contractors bidding for commercial plumbing services with the VA Pacific Islands Health Care System (VAPIHCS) under Solicitation No. 36C26126Q0516. The survey is directed to past performance references identified by offerors and must be completed and returned directly to Karen Cooper, Contract Specialist, at karen.cooper332@va.gov by August 12 at 11:00 AM PDT. The Government seeks feedback on contractors' experience with work similar to the solicitation requirements, including routine repairs, emergency response, troubleshooting, minor plumbing installations, healthcare or federal facility work, safety compliance, subcontractor management, and timely completion of authorized work.
The survey evaluates contractor performance across eleven key areas: quality of work, routine response and timeliness, emergency response, technical capability and diagnostics, estimate accuracy and reasonableness, safety compliance, staffing and supervision, subcontractor management, communication and customer service, administrative performance and invoicing, and problem resolution. References rate performance using a six-point scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, and N/A) and provide narrative responses regarding contractor strengths, performance concerns or delays, quality or safety issues, required Government oversight, and likelihood of future contract award. The survey concludes with an overall recommendation section requesting a yes/no/with reservations recommendation and confidence level assessment (high, moderate, or low).
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26126Q0516 0001.docx | DOCX document | |
| Attachment 3 - Pricing Worksheet.xlsx | XLSX spreadsheet | |
| 36C26126Q0516_Commercial Plumbing Services.docx | DOCX document | |
| Combined Synopsis_36C26126Q0516_Commercial Plumbing Services.docx | DOCX document | |
| Attachment 1 - WD 2015-5689 REV 30 dated 05-13-2026.pdf |
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Text version
Commercial Plumbing Services - Past Performance Survey
PAST PERFORMANCE SURVEY
Commercial Plumbing Services VA Pacific Islands Health Care System (VAPIHCS) Solicitation No. 36C26126Q0516
Instructions to Reference You have been identified as a past performance reference for an offeror responding to the above solicitation. Please complete this survey based on your experience with the contractor. The Government may use this information to evaluate past performance and support responsibility determinations.
Please return the completed survey directly to Karen Cooper, Contract Specialist, at karen.cooper332@va.gov by 12 Aug, 11:00am PDT. Do not return the completed survey to the offeror.
The Government is seeking feedback on work similar to commercial plumbing services, including routine repairs, emergency response, troubleshooting, minor plumbing installations, healthcare or federal facility work, safety compliance, subcontractor management, and timely completion of authorized work.
1. Offeror / Contractor Being Evaluated Offeror / Contractor Name:
Contract / Order Number:
Project / Requirement Title:
Period of Performance:
2. Reference Information Reference Name / Title:
Organization:
Phone Number:
Email Address:
Date Survey Completed:
| May the Government contact you for clarification? |
| Yes: ________ No: ________ |
3. Contract / Project Relevance Please briefly describe the work performed by the contractor and indicate whether the effort included any of the following:
| ☐ Routine plumbing repairs / work orders |
| ☐ Emergency plumbing response |
| ☐ Troubleshooting / diagnostics |
| ☐ Minor plumbing installation |
| ☐ Healthcare environment |
| ☐ Federal, state, or local government facility |
| ☐ Work requiring licensed plumbing personnel |
| ☐ Work involving subcontractors |
| ☐ After-hours, weekend, or holiday response |
| ☐ Other similar recurring maintenance service |
| ☐ Approx. contract value: $______________ |
| ☐ Approx. service calls/work orders: __________ |
Rating Key
| Exceptional |
| Greatly exceeded requirements |
| Very Good |
| Exceeded some requirements |
| Satisfactory |
| Met requirements |
| Marginal |
| Did not consistently meet requirements |
| Unsatisfactory |
| Failed to meet requirements |
| N/A |
| Not applicable or unknown |
4. Performance Evaluation Place an X in the rating column that best reflects the contractor’s performance.
| Performance Area |
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Quality of work
Routine response / timeliness
Emergency response
Technical capability / diagnostics
Estimate accuracy / reasonableness
Safety compliance
Staffing / supervision
Subcontractor management, if applicable
Communication / customer service
Administrative performance / invoices
Problem resolution
Overall performance
5. Narrative Questions
a. What were the contractor’s strengths?
b. Were there any performance concerns, delays, quality issues, safety issues, or recurring problems? If yes, please explain.
c. Did the contractor require significant customer/Government oversight to meet requirements? If yes, please explain.
d. Would you award another contract/order to this contractor for similar commercial plumbing services? Why or why not?
6. Overall Recommendation
| Would you recommend this contractor for similar work? |
| Yes: ________ No: ________ With Reservations: ________ |
| Overall confidence in contractor performance: |
| High: ________ Moderate: ________ Low: ________ |
Additional comments:
Reference Signature: __________________________________________ Date: __________________ Attachment 2 - Past Performance Survey
File details come from the government source that posted it. Updated .