ATTACHMENT 4 PAST PERFORMANCE QUESTIONNAIRE.pdf

Attachment 4 - Past Performance Questionnaire 36C24823Q0001

PAST PERFORMANCE QUESTIONNAIRE

Instructions: Complete Section 2 of this form for the Contractor noted below in Section 1, who is requesting you as a Reference. Email this form to the Contract Specialist noted below.

Contract Specialist: Mark L. Cline

Email: mark.cline@va.gov

1) CONTRACTOR/OFFEROR INFORMATION:

Company: ______________________________________________

Point of Contact: _________________________________________

Phone: _____________________

2) REFERENCE INFORMATION:

Company: ______________________________________________

Point of Contact: _________________________________________

Phone: _____________________

Type of Work the Contractor Performed: _____________________________________________________

Contract Period: _________________________________________

Length of Services Performed: ______________________________

Estimated Contract Award Amount: __________________________

For the following questions, please check the level of performance which most accurately describes the Contractor’s performance on the contract referenced above. You may include brief comments under the rating.

1) Evaluate the company’s compliance with contractual terms and conditions, and the technical requirements of the contract.

Acceptable Unacceptable Neutral/Unknown

Comments: ___________________________________________________________________________

2) Has the company demonstrated reasonable cooperative behavior in resolving customer requests and/or complaints?

Acceptable Unacceptable Neutral/Unknown

Comments: __________________________________________________________________________

3) Did the contractor notify the appropriate staff in a timely manner upon discovery of any deficiencies/non-conformances during inspections which may have had the potential of an adverse impact?

Acceptable Unacceptable Neutral/Unknown

Attachment 4 - Past Performance Questionnaire 36C24823Q0001 Comments:

4) Did the contractor make themselves available in a timely manner for consultation or advice as needed?

Acceptable Unacceptable Neutral/Unknown

Comments:

5) Invoices were found to be accurate and Acceptable Unacceptable Neutral/Unknown submitted timely?

Acceptable Unacceptable Neutral/Unknown

Comments:

6) Rate the company’s overall performance Acceptable Unacceptable Neutral/Unknown

Acceptable Unacceptable Neutral/Unknown

Comments:

7) Would you award to this company again?

Acceptable Unacceptable Neutral/Unknown

Comments:

Please provide any additional comments you would like to let us know about: