Attachment 6 - Past Performance Questionnaire.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C10G26Q0001
About this file
This document is a Past Performance Questionnaire (PPQ) for a Department of Veterans Affairs (VA) solicitation numbered 36C10G26Q0001, specifically for a Vacuum Erection Device (VED) contract. The PPQ is a comprehensive evaluation form designed to assess a contractor's performance across multiple dimensions, including overall quality, delivery performance, service quality, problem resolution, and personnel effectiveness, using a 1-5 rating scale. The questionnaire requires detailed feedback from previous contracting officers, covering aspects such as contract performance, potential terminations, likelihood of future contract awards, and specific contract details like period of performance and total contract value.
The related federal contract opportunity is a solicitation for Automatic and Manual Vacuum Erectile Devices, issued by the VA Headquarters. The PPQ serves as a critical component of the source selection process, allowing the contracting officer to gather comprehensive past performance information from previous clients to inform the award decision for this medical device procurement. The document provides a structured method for collecting qualitative and quantitative performance data, with sections for both numerical ratings and narrative explanations of a contractor's performance history.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G26Q0001 0001.docx | DOCX document | |
| Attachment 5 - VED Q and A.xlsx | XLSX spreadsheet | |
| Attachment 7 - Sample Letter of Supply.docx | DOCX document | |
| Attachment 5 - VED Questions.xlsx | XLSX spreadsheet | |
| Attachment 1 - Schedule of Supplies.xlsx | XLSX spreadsheet | |
| Attachment 8 - Authorized Gov Distributor Letter.docx | DOCX document | |
| Attachment 2 - Pay.gov Vendor Submittal Instructions.docx | DOCX document | |
| 36C10G26Q0001.docx | DOCX document | |
| Attachment 4 - Contract Discrepancy Report.pdf | ||
| Attachment 3 - Quarterly Reporting Tool.xlsx | XLSX spreadsheet |
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Text version
Attachment 6, PPQ 36C10G26Q0001
PAST PERFORMANCE QUESTIONNAIRE (PPQ)
Request for Proposal (RFP) No.: 36C10G26Q0001 Title: Vacuum Erection Device (VED)
| TO: Shemika Wray, Contracting Officer | AGENCY: VA, SAC | |
| PHONE: 202-288-2144 | E-MAIL: Shemika.wray@va.gov |
INFORMATION REQUEST: PAST PERFORMANCE
The Department of Veterans Affairs is currently in the process of awarding a competitive service contract. [CONTRACTOR NAME] has provided this Questionnaire to you for a reference regarding [CONTRACTOR NAME]’s record of past performance under Contract No. [CONTRACT #].
Send completed questionnaires to Shemika.Wray@va.gov and Brian.Love@va.gov.
NOTE TO OFFERORS: If the Questionnaire is provided for subcontractor’s reference, the offeror’s name below must include both the prime and subcontractor names (e.g. contractor X, who is a subcontractor to offeror Y for this solicitation).
Contractor’s Name:
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. 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.
7. 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.
8. Based on the contractor’s overall performance, would you award them another contract?
|_| Yes |_| No If No, please explain.
9. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? |_| Yes |_| No Please explain.
10. Do you file past performance information in a database that the Contracting Officer may search?|_| Yes |_| No Please explain.
11. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
12. What was the contract period of performance (i.e., when were services provided)?
13. What was the dollar value of the contract performed by the contractor?
14. Provide a brief description of the services provided by the contractor for this contract.
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. Please provide information on any adverse performance by the contractor and the corrective actions taken.
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