Attachment 6 - Past Performance Questionnaire.docx
DOCX document 20 KB Posted
- Solicitation number
- 36C24922R0002
About this file
This combined synopsis/solicitation from the Department of Veterans Affairs seeks proposals for radiological physicist inspection services at the Tennessee Valley Veteran Healthcare facility in Nashville, Tennessee. The one-year base contract starting October 1, 2022 includes a cost schedule and four one-year option periods extending to September 30, 2027. Proposals are due by July 1, 2021 and the award will be a firm-fixed-price contract to the responsible offeror providing the best value based on technical qualifications, past performance references, and total evaluated price for the base year and all option periods. The solicitation is set aside for service-disabled veteran-owned small businesses and offers guidance on the technical, past performance, and price evaluation criteria.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24922R0002 0002.docx | DOCX document | |
| Attachment 1 Physics SOW.docx | DOCX document | |
| 36C24922R0002 0001.docx | DOCX document | |
| Attachment 2 Price Schedule.doc | DOC document | |
| Attachment 1 Physics PWS.docx | DOCX document | |
| Attachment 3 - Contractor Certification of Immigration.docx | DOCX document | |
| 36C24922R0002.docx | DOCX document | |
| Attachment 7 equiptment list.docx | DOCX document | |
| Attachment 4 - Contractor Rules of Behavior.docx | DOCX document | |
| Attachment 5 - Org Conflict of Interest.docx | DOCX document |
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36C24922R0002 – Physicists Inspection, Tennessee TVH VAMC
Attachment 6 – Past Performance Questionnaire
PAST PERFORMANCE QUESTIONNAIRE
REFERENCE INSTRUCTIONS: The Network Contracting Office 9 is soliciting for award of a VA contract for Physicists Inspections. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate contractors who have provided Physicists Inspection Services in the past.
Survey must be completed by evaluator and sent to Cinnamon Washington at cinnamon.washington@va.gov no later than June 24, 2021.
Information of Company to be Evaluated
| Company name: | ________________________________ | ||
| Address: | ________________________________ | ||
| ________________________________ | |||
| Phone: | ________________________________ | ||
| Email: | ________________________________ |
Information of Evaluating Agency
| Evaluator’s name: | ________________________________ | ||
| Title: | ________________________________ | ||
| Agency name: | ________________________________ |
Information regarding your Contract with the company to be evaluated:
| Estimated Contract Amount: | ________________________________ | |
| Contract Period of Performance: | ________________________________ | |
| Type of Services rendered: | ________________________________ |
Please evaluate the past performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.
“O” = Outstanding = Performance greatly exceeded the contract requirements
“A” = Above Average = Performance exceeded the contract requirements
“S” = Satisfactory = Performance met the contract requirements
“M” = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory
“U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements
| Please rate and provide information/comments for the following: |
| Circle one |
Q1. To what extent did the contractor comply with contract requirements?
O A S M U
Q2. If reports were required, were they accurate in meeting contract requirements?
O A S M U
Q3. To what extent did the contractor use appropriate personnel for contract requirements?
O A S M U
| Please rate and provide information/comments for the following: |
| Circle one |
Q4. To what extent was contractor able to meet the performance schedule:
O A S M U
Q5. What extent was contractor flexible in responding to changing needs?
O A S M U
Q6. To what extent was the contractor reliable?
O A S M U
Q7. To what extent was the contractor responsive to technical directions?
O A S M U
Q8. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
Yes No
Q9. Would you award another contract to the party being evaluated? If no, please explain:
Yes No
Q10. To what extent did contractor notify you of problems or potential problems?
O A S M U
11. Please describe services provided under your contract, period of performance and total cost:
12. Additional Remarks:
Signature of Evaluator
Date
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