Attachment 5 - Past Performance Questionnaire - EIS.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C10G20Q0050
About this file
This document contains a combined synopsis and solicitation for an Endoscopy Information System. The Department of Veterans Affairs is seeking to establish a one-year requirements contract with four one-year options for a brand name or equal Endoscopy Information System. Interested vendors must be registered in SAM and provide a quote for all contract line items by February 15, 2021. The solicitation will be awarded as a tiered evaluation with priority given to SDVOSBs, VOSBs, small businesses, and then large businesses. The contract will have a maximum value of $41.5 million and support VA medical centers nationwide.
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Department of Veterans Affairs:
INFORMATION REQUEST: PAST PERFORMANCE QUESTIONNAIRE
The Department of Veterans Affairs is currently in the process of awarding a competitive enterprise wide strategic contract for ENDOSCOPY INFORMATION SYSTEM (EIS). This questionnaire has been sent to you for a reference for solicitation:
Send completed questionnaires to sharon.redman@va.gov and kevin.pendleton@va.gov. Please fill the subject line of the e-mail as:
[Company Name] – Past Performance Questionnaire – 36C10G20Q0050 – EIS.
NOTE TO CONTRACTORS: If the Questionnaire is provided for Subcontractors reference, the contractor’s name below must include both the Prime and Subcontractor Names.
PAST PERFORMANCE QUESTIONNAIRE
Contractor’s Name:
Subcontractor’s Name (if applicable):
BPA/Contract/Task Order Number:
Name of Person Completing the Evaluation:
Telephone: E-mail:
Title:
Company/Organization:
Please rate the contractor in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.
Not Applicable: N/A 1 = Performance clearly below the contract performance standard or requirement.
2 = Performance occasionally does not meet minimum contract performance standard or requirement.
3 = Performance that meets the minimum contract performance standard or Requirement.
4 = Performance that meets and occasionally exceeds the contract performance standard or requirement.
5 = Performance that almost always exceeds the contract performance standard or requirement
| 1. Overall quality/satisfaction |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Overall satisfaction with the Contractor’s performance.
| 2. Delivery performance |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.
| 3. Satisfaction with the quality of service delivered |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.
| 4. Satisfaction with problem resolution |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
This includes the contractor’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.
| 5. Satisfaction with the quality of contractor personnel |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the quality of the contractor’s staff in executing the project work scope.
| 6. Satisfaction with the quality of product (software/hardware solution) past performance. |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the overall quality of the product performance (e.g., procedure documentation process, procedure reports, analytics/quality reports, interface(s) performance, interoperability with VistA/CPRS and VistA Imaging).
7. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years? |_| Yes |_| No If Yes, please explain.
8. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions? |_| Yes |_| No If Yes, please explain.
9. Based on the contractor’s overall performance, would you award them another contract? |_| Yes |_| No If No, please explain.
10. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? |_| Yes |_| No Please explain.
11. Do you file past performance information in a database that the Contracting Officer may search? |_| Yes |_| No Please explain.
12. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
13. What was the contract period of performance (i.e., when were services provided)?
14. What was the dollar value of the contract performed by the contractor?
15. Provide a brief description of the services provided by the contractor for this contract.
16. Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Contractor’s past performance by the evaluator.
17. Please provide information on any adverse performance by the contractor and the corrective actions taken.
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