Attachment 7 - 668-26-103S - Past Performance Questionnaire.docx
DOCX document 113 KB Posted
- Solicitation number
- 36C26026R0102
About this file
This is a Past Performance Questionnaire (PPQ) template used by the Department of Veterans Affairs Network Contracting Office 20 to evaluate contractor performance on past projects relevant to solicitation 36C26026R0102 for Pharmacy Cache HVAC Repair in Spokane, WA.
The form is completed in two sections: contractors provide detailed contract information including project scope, contract pricing, award dates, and contract acceptance dates, while client evaluators assess contractor performance across seven criteria—quality, schedule/timeliness, communication, management/personnel/labor, cost/financial management, subcontract management, and overall suitability for future work. Evaluators rate performance using an adjectival scale (Outstanding, Above Average, Satisfactory, Unsatisfactory, or Not Applicable) with specific definitions provided. The questionnaire requires evaluator contact information, role description, and detailed comments supporting each rating, with a final determination of whether the evaluator would hire or work with the contractor again. Contractors are responsible for collecting completed PPQs from past clients and submitting them as part of their proposal package by the solicitation due date.
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Text version
NETWORK CONTRACTING OFFICE 20 ●
1601 E. FOURTH PLAIN BLVD BLDG. 17, SUITE B428 ● VANCOUVER, WA 98661
Department of Veterans Affairs (VA)
PAST PERFORMANCE QUESTIONNAIRE (PPQ)
SECTION 1
CONTRACT INFORMATION – Contractor to complete #1-3
1. CONTRACTOR INFORMATION
NAME OF OFFEROR BEING EVALUATED: Click or tap here to enter text.
ADDRESS: Click or tap here to enter text.
POINT OF CONTACT: Click or tap here to enter text.
CONTACT PHONE NUMBER: Click or tap here to enter text.
CONTACT EMAIL ADDRESS: Click or tap here to enter text.
WORK PERFOMED AS: Click or tap here to enter text.
PERCENT OF PROJECT WORK PERFORMED: Click or tap here to enter text.
IF SUBCONTRACTOR, WHO WAS THE PRIME? Click or tap here to enter text.
2. CONTRACT INFORMATION
CONTRACT TITLE: Click or tap here to enter text.
CONTRACT NUMBER AND DO/TO NUMBER: Click or tap here to enter text.
CONTRACT TYPE: Choose an item.
if other:
CONTRACT LOCATION: Click or tap here to enter text.
AWARD DATE: Click or tap to enter a date.
ORIGINAL CONTRACT ACCCEPTANCE (construction accepted) Date: Click or tap to enter a date.
ACTUAL CONTRACT ACCEPTANCE: Click or tap to enter a date.
EXPLAIN DIFFERENCES: Click or tap here to enter text.
ORIGINAL CONTRACT PRICE (all costs - design/installation/financing): Click or tap here to enter text.
FINAL CONTRACT PRICE (including modifications, if applicable): Click or tap here to enter text.
EXPLAIN DIFFERENCES: Click or tap here to enter text.
3. PROJECT DESCRIPTION
SCOPE INCLUDED IN PROJECT: Click or tap here to enter text.
HOW IS THIS PROJECT RELEVANT TO PROJECT OF SUBMISSION? Click or tap here to enter text.
SECTION 2
EVALUATOR INFORMATION – Client to complete
Veterans Health Administration (VHA) Regional Procurement Office-West (RPOW) Network Contracting Office 20 (NCO 20) is considering the Offeror identified above for award of the 668-26-103S Pharmacy Cache HVAC Repair, Spokane, WA – 36C26026R0102.
Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the company’s ability to perform the work as described in the solicitation. Please verify the accuracy of the information in Section 1 and complete the questionnaire as thoroughly as possible. NCO 20 may contact you in order to obtain any additional information regarding a contract award.
The Offeror is responsible for collecting all completed PPQs and submitting them as part of their proposal package by the solicitation due date.
EVALUATOR INFORMATION
NAME OF EVALUATOR: Click or tap here to enter text.
POSITION: Click or tap here to enter text.
ADDRESS: Click or tap here to enter text.
PHONE: Click or tap here to enter text.
EMAIL: Click or tap here to enter text.
DESCRIBE YOUR ROLE IN THE PROJECT: Click or tap here to enter text.
*Please see Page 4 for Adjectival Ratings for the following:
1. QUALITY
| Ability to meet quality design and/or construction standards specified for technical performance |
| Choose an item. |
| Comments: |
2. SCHEDULE/ TIMELINESS OF PERFORMANCE
| Compliance with contract delivery/completion schedules including timely submission of data deliverables (If liquidated damages were assessed or the schedule was not met, please address below.) |
| Choose an item. |
| Comments: |
3. COMMUNICATION
| Contractor was reasonable and cooperative in dealing with client staff (including the ability to successfully resolve disagreements/disputes and responsiveness to client requests) |
| Choose an item. |
| Comments: |
4. MANAGEMENT/ PERSONNEL/ LABOR
| Effectiveness of management, including suppliers, materials, and/or labor force (including the ability to effectively lead, manage, and control the project) |
| Choose an item. |
| Continuity in the contractor’s personnel during execution of the contract (e.g., one person or team that stayed with the project throughout the contract) |
| Choose an item. |
| Comments: |
5. COST/ FINANCIAL MANGEMENT
| Ability to meet the terms and conditions within the contractually agreed price |
| Choose an item. |
| Comments: |
6. SUBCONTRACT MANAGEMENT
Ability to manage subcontracting effort, including any subcontracting issues, and the contractor’s ability to resolve the problems without extensive customer guidance
Choose an item.
Comments:
7. SUMMARY
| Would you hire or work with this firm again? If no, please explain below. |
| Choose an item. |
| Provide an overall rating for the work performed by this contractor. |
| Choose an item. |
ADDITIONAL COMMENTS:
| EVALUATOR SIGNATURE: |
| DATE: |
ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE
*THIS PAGE WILL BE REMOVED AS IT IS FOR PPQ COMPLETION PURPOSES ONLY*
| Rating |
| Definition |
| Outstanding |
| The Offeror’s performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Offeror were highly effective. |
| Above Average |
| The Offeror’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Offeror were effective. |
| Satisfactory |
| The Offeror’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Offeror were satisfactory. |
| Unsatisfactory |
| Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the Offeror has yet to identify corrective actions or the Offeror’s proposed actions appear only marginally effective or were not fully implemented. |
| Not Applicable |
| No information or did not apply to your contract. |
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