Attachment 6 - Past Performance Questionnaire.docx
DOCX document 25 KB Posted
- Solicitation number
- 36C79121R0015
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Other files
| File | Type | Posted |
|---|---|---|
| 36C79121R0015 0001.docx | DOCX document | |
| 36C79121R0015.docx | DOCX document | |
| Attachment 1 - Contractor Discrepancy Report.docx | DOCX document | |
| Attachment 5 - Past Performance Template.docx | DOCX document | |
| Attachment 2 - Schedule of Supplies Items Template.xlsx | XLSX spreadsheet | |
| Attachment 3 -Minimum Technical Requirements ( MTR)_Worksheet.docx | DOCX document | |
| Attachment 4 - Questions.xlsx | XLSX spreadsheet |
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Attachment 6 Past Performance Questionnaire
The following Offeror has submitted a proposal for Solicitation Number 36C79121R0009 – Transcutaneous Electrical Nerve Stimulation (TENS) and has referenced your company in their past performance. Please provide information on the past performance of the offeror under evaluation by completing this document and returning to the Contracting team.
| Solicitation Number |
| 36C79121R0009 |
Name of Offeror under Evaluation
Submit document by email to: Susan Dela Cruz at Susan.Delacruz@va.gov and Joseph Hodge at Joseph.Hodge@va.gov.
Subject Line should read as: Solicitation #, Past Performance Questionnaire Describe the nature of your contract with the referenced Vendor (If more space is needed, please use the (“Additional Comments” block on the second page) Company/Organization Providing Reference
Company Representative Completing Questionnaire
Company Representative Email
Company Representative Phone Number
Contract Description the Offeror was Awarded
Contract Number or Project ID
Period of Performance
Contract Award Amount
What was the role of Offeror? Prime or Subcontractor?
Complete the following questions, by marking the adjectival ratings and providing comments in which there was substantial confidence or no confidence in performance.
PLEASE NOTE: In accordance with Federal Acquisition Regulations, contractors may be advised of adverse remarks and given an opportunity to respond. However, the contracting officer will not provide your name or copies of this questionnaire to the contractor or any other party not directly involved in the evaluation of the contractor’s proposal.
ADJECTIVAL RATINGS DEFINITIONS
Substantial Confidence
(SUBC)
Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.
Satisfactory Confidence
(SATC)
Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.
Limited Confidence
(LC)
Based on the offeror’s recent/relevant performance record, the Government has a low expectation the offeror will successfully perform the required effort.
No Confidence
(NC)
Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.
Unknown Confidence/Neutral
(UC)
No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.
| PAST PERFORMANCE |
| ADJECTIVAL RATINGS |
| 1. How well were the contract requirements met in compliance with contractual terms and conditions? Compliance of technical data/report preparation terms? |
| SUBC |
SATC
| LC |
| NC |
| UC |
Comments:
| 2. To what extent did the contractor adhere to the Performance schedule? Quality Control? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 3. How responsive was the contractor in resolving quality, schedule, or other contract issues? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 4. How effective was the contractor in addressing unforeseen or unusual customer needs and issues? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
5. How well was the contractor in ability to meet quality standards for technical performance?
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
6a. If you represent a government agency, and the contract included a small business subcontracting plan, how well did the contractor adhere to the plan requirements?
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6b. If you represent a government agency, and the Contract included a small business subcontracting plan, how was performance against subcontract goals? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6c. If you represent a government agency, and the contract included a small business subcontracting plan, how was compliance with subcontracting plan in general? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6d. If you represent a government agency, and the contract included a small business subcontracting plan, was there timely eSRS reporting? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 7. How satisfied were you with the contractor’s overall performance? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
Additional Comments:
Thank you for your response.
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