Attachment 4 - Past Performance Questionnaire.docx

This is a Past Performance Questionnaire template for the Triennial Electrical Inspection Services solicitation (36C26126Q1088) issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21. The questionnaire is designed to be completed by previous clients or contract references to evaluate an offeror's past performance on similar work. Evaluators are instructed to provide information about contracts previously performed by the company being evaluated, including total contract amount, performance dates, and contract number, then rate the overall quality of work on a scale of Excellent, Good, Fair, Marginal, or Unacceptable with supporting comments. The form also requests identification of any performance issues or concerns and how they were resolved. Completed surveys must be submitted to jill.williams@va.gov with evaluator identity kept confidential per VA policy.

This is an appendix/template document rather than a document specifying required services or contract terms. The actual scope of work for triennial electrical inspection services is contained in the associated Performance Work Statement referenced in the solicitation. The opportunity is a 100 percent Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside.