ATTACHMENT 4 - Past Performance Forms.pdf
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- Solicitation number
- 36C24826R0090
About this file
This is a Past and Present Performance Questionnaire used by the Department of Veterans Affairs to evaluate contractor performance on past and present contracts during the source selection process.
The form captures general information about the contractor being evaluated, including the contractor's name, contact details, project title, contract number, dollar amount, performance period, and the contractor's role (prime contractor, subcontractor, or key personnel). Respondents must provide their own identifying information and submit completed forms to apolinar.vargas@va.gov. The evaluation employs a six-point rating scale (1-6) corresponding to performance levels: Exceptional (E), Good (G), Satisfactory (S), Marginal (M), Unsatisfactory (U), and Neutral (N), with narrative explanations required for any Marginal or Unsatisfactory ratings. The questionnaire assesses 26 performance areas including management and staffing capabilities, quality control procedures, schedule performance, safety compliance, warranty resolution, and responsiveness to contract changes. Work element-specific items evaluate contractor performance on standing seam metal roof installation, brick veneer installation, HVAC equipment and ductwork installation, Trane Direct Digital Controls installation, HVAC testing and balancing, and phased construction. Yes/No questions address contractor cooperation with government personnel, receipt of cure or show cause notices, contractor willingness to award future contracts, and environmental compliance history. A remarks section allows respondents to provide additional context and explanation for ratings. The form notes that separate evaluation forms should be completed for any other contracts the offeror has held with the agency within the last three years.
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(WHEN FILLED IN)
SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104
FOR OFFICIAL USE ONLY
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
A. GENERAL INFORMATION: (Contractor to be evaluated)
Contractor’s Name:
Telephone Number: Fax Number:
Address: Point of Contact:
E-mail:
Project Title and Brief Description of Work: ______________________________________ *
Contract Number Provided by Offeror: _____________________ Dollar Amount: _______ *
Contract Period or Dates of Performance Provided by Offeror: *
Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.
* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.
(WHEN FILLED IN)
SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104
FOR OFFICIAL USE ONLY
SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104
FOR OFFICIAL USE ONLY
B. RESPONDENT INFORMATION:
Name of Respondent: Title:
Address: Telephone Number:
Fax Number:
Email Address:
C. E-MAIL COMPLETED SURVEY FORM TO: apolinar.vargas@va.gov
D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.
PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.
E G S M U N
Exceptional Good Satisfactory Marginal Unsatisfactory Neutral
Performance meets/met contractual requirements with many exceeded to the
Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.
Performance meets/met contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.
Performance meets/met contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.
Performance does not meet/did not meet some contractual requirements.
The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet
Identified Corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.
Performance does not meet/did 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.
Performance was not observed or not applicable to the current effort being reported against.
(WHEN FILLED IN)
FOR OFFICIAL USE ONLY
CONTRACTOR’S NAME: CONTRACT NUMBER:
Place an “X” in the appropriate column using the definitions matrix above.
The contractor:
1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
1 2 3 4 5 6 NA
2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.
1 2 3 4 5 6 NA
3. Delegated authority to project managers and supervisors commensurate with contract requirements.
1 2 3 4 5 6 NA
4. Home office participated in solving significant local problems. 1 2 3 4 5 6 NA
5. Followed approved quality control plan. 1 2 3 4 5 6 NA
6. Provided effective quality control and/or inspection procedures to meet contract requirements.
1 2 3 4 5 6 NA
7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.
1 2 3 4 5 6 NA
8. Provided timely resolution of contract discrepancies. 1 2 3 4 5 6 NA
9. Identified risks/problems as they occurred. 1 2 3 4 5 6 NA
10. Suggested alternative approaches to problems. 1 2 3 4 5 6 NA
11. Displayed initiative to solve problems. 1 2 3 4 5 6 NA
12. Developed realistic progress schedules. 1 2 3 4 5 6 NA
13. Met established project schedules. 1 2 3 4 5 6 NA
14. Provided timely resolution of warranty defects. 1 2 3 4 5 6 NA
15. Was responsive to contract changes. 1 2 3 4 5 6 NA
16. Provided adequate project supervision. 1 2 3 4 5 6 NA
17. Obtained consent of surety for increases in bonding as work-in-progress increased.
1 2 3 4 5 6 NA
18. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6 NA
19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.
1 2 3 4 5 6 NA
20. With respect to the safety plan, the contractor:
a. Followed the approved safety plan. 1 2 3 4 5 6 NA
(WHEN FILLED IN)
SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 4.104
FOR OFFICIAL USE ONLY
b. Had no significant safety problems at the job site. 1 2 3 4 5 6 NA
21. The contractor met contractual requirements for the following work elements:
a. Installation of standing seam metal roof 1 2 3 4 5 6 NA
b. Installation of brick veneer 1 2 3 4 5 6 NA
c. Installation of HVAC equipment and ductwork 1 2 3 4 5 6 NA
d. Installation of Trane Direct Digital Controls 1 2 3 4 5 6 NA
e. Testing, Adjusting, and Balancing of HVAC systems 1 2 3 4 5 6 NA
f. Phased Construction 1 2 3 4 5 6 NA
22. Cooperated with Government personnel after award. YES NO
23. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
YES NO
24. Would you award another contract to this contractor? If not, explain in “remarks.”
YES NO
25. Has contractor demonstrated a history of environmental compliance? If not, explain in “remarks.”
YES NO
26. How would you rate the contractor's overall performance? 1 2 3 4 5 6 NA
Remarks:
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