Attachment 6 - Past Performance Survey.pdf
PDF 279 KB Posted
- Attached to
- Emergency Department Physician
- Solicitation number
- 36C25722R0050
About this file
This document contains a past performance survey for emergency physicians and details of a related federal contract opportunity. The Department of Veterans Affairs Network Contracting Office 17 is seeking emergency physician services through competitive acquisition RFP number 36C25722R0050. Offerors must provide references that will be sent a survey to validate past performance by August 18th. The survey collects information on contract length, services provided, location, value, full time equivalents provided, time to credential new physicians, and ratings for quality of care, business relationship, and whether the reference would award another contract. The opportunity is for emergency department physicians to support Veterans Integrated Service Network 17. No further details are provided on pricing, response dates, or awards.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 5 - Background Investigation Information.docx | DOCX document | |
| 2nd Set of Contractor Questions-COR response.docx | DOCX document | |
| 1st Set of Questions-COR response.docx | DOCX document | |
| Conformed Copy of RFP - 36C25722R0050 as of 8-16-2022.pdf | ||
| 3rd set of Contractor Questions and Answers.docx | DOCX document | |
| Attachment 5 - Background Investigation Form.docx | DOCX document | |
| Attachment 1 - QASP.docx | DOCX document | |
| RFP - 36C25722R0050.pdf | ||
| Attachment 3 - Immigration and Nationality Certification.docx | DOCX document | |
| Attachment 2 - Organizational Conflict of Interest Certification.docx | DOCX document | |
| Attachment 4 - Contractor Rules of Behavior.docx | DOCX document |
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ATTACHMENT 6
RFP# 36C25722R0050
Emergency Physicians
PAST PERFORMANCE SURVEY
The Department of Veterans Affairs Network Contracting Office 17 is conducting a competitive acquisition.
The offeror has identified you as a reference to validate the offeror’s past performance. Please complete the following survey to assist our evaluation of the contractor’s past performance and return no later than 1:00 pm
MDT, August 18, 2022, to Rashonda Jones, NCO 17 El Paso, TX via email at rashonda.jones@va.gov.
Name of Contractor being evaluated: _________________________________________________________
1. How long has your company had a contract with this contractor? ________________________________
2. Type of services being provided? _________________________________________________________
3. Where is the location where services are provided? ___________________________________________
4. What is the total value of the contract? _____________________________________________________
5. How may Full Time Equivalents (FTE) are being provided under the contract? _____________________
6. What is the average length of time it took to place a provider in your facility from the time of award? Please explain any delays in providing documentation for credentialing, background investigations, etc.
7. How would you rate the quality of the medical providers supplied?
Exceptional______ Very Good______ Satisfactory______ Marginal______ Unacceptable______
If less than less than satisfactory please provide an explanation:
8. How would you rate the Business/Customer Relationship with the Contractor? (Concern for customer’s interest; successfully managed services; reasonable/cooperative behavior)
Exceptional______ Very Good______ Satisfactory______ Marginal______ Unacceptable______
If less than less than satisfactory please provide an explanation:
9. Would you award another contract to this contractor? Yes______ No______ mailto:sandra.archuleta@va.gov
ATTACHMENT 5
10. Please provide any other examples or comments concerning the contractor’s performance that would be relevant in assessing the probability of successful contract performance:
Rating System:
Exceptional: Performance meets contractual requirements and exceeds many to the customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective action taken was highly effective.
Very Good: Performance meets contractual requirements and exceeds some to the customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective action taken were effective.
Satisfactory: Performance meets contractual requirements. The contractual performance contains some minor problems for which corrective action taken appear or were satisfactory.
Marginal: Performance does not meet some contractual requirements. The contractual performance of reflects a serious problem for which the contractor has not yet identified corrective actions. The proposed actions appear only marginally effective or were not fully implemented.
Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractor performance contains serious problem(s) for which corrective actions appear or were ineffective.
Signature________________________________ Date_____________________
Printed Name_____________________________
Organization_____________________________
Title____________________________________
Telephone_______________________________
Email Address____________________________
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