Attachment 5 - Past Performance Questionnaire PPQ- Dental Network.docx
DOCX document 31 KB Posted
- Attached to
- Q503--CCN Next Gen - Dental Network
- Solicitation number
- 36C10G26R0004
About this file
The document is a Past Performance Questionnaire (PPQ) for a Department of Veterans Affairs (VA) dental network contract. The PPQ is designed to collect detailed performance feedback from previous contract references, using a 5-point rating scale to evaluate contractor performance across key areas including overall quality, delivery performance, service quality, problem resolution, and personnel quality.
The questionnaire seeks comprehensive information about a contractor's past performance, including contract details such as period of performance, dollar value, and service description. It also includes critical assessment questions about potential performance issues like cure notices, contract terminations, and willingness to re-award a contract. The document is specifically related to Solicitation Number 36C10G26R0004 for the Community Care Network (CCN) Next Generation Dental Network, which is a combined synopsis/solicitation issued by the VA in accordance with FAR Part 12.6.
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Text version
ATTACHMENT A: PAST PERFORMANCE QUESTIONAIRRE
Past Performance Questionnaire Department of Veterans Affairs: <Sol. Number>
| E-MAIL TO: Contract Specialist | AGENCY: Veterans Affairs (VA) | |
| E-MAIL: xxx@va.gov | PHONE: xxx-xxx-xxxx |
INFORMATION REQUEST: PAST PERFORMANCE
This office is currently in the process of awarding a competitive service contract. [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR NAME]’s record of past performance under Contract No. [CONTRACT NO.].
PAST PERFORMANCE QUESTIONNAIRE
Offeror’s Name:
Request for Proposal: <Program/ Requirement Name>
Name of Person Completing the Evaluation:
| Telephone: | E-mail: | |
| Title: | Company/Organization: |
Please rate the offeror 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 offeror’s performance. Would you (the reference) choose to work with this offeror again?
| 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 offeror’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.
1. 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.
1. 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.
1. Based on the offeror’s overall performance, would you award them another contract? |_| Yes |_| No If No, please explain.
1. Have you discussed any adverse past performance problems with the Offeror and given them an opportunity to comment? |_| Yes |_| No Please explain.
1. Do you file past performance information in a database that the Contracting Officer may search? |_| Yes |_| No Please explain.
1. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
1. What was the contract period of performance (i.e., when were services provided)?
1. What was the dollar value of the contract performed by the offeror?
1. Provide a brief description of the services provided by the offeror for this contract.
Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Offeror’s past performance by the evaluator.
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