Attachment 7 - Past Performance Questionnaire.docx
DOCX document 27 KB Posted
- Attached to
- National Clinical Documentation Imaging Federal contract opportunity
- Solicitation number
- 36C10G23R0003
About this file
This document contains a past performance questionnaire for a contractor providing standard manual wheelchairs and accessories to the Department of Veterans Affairs. The questionnaire requests ratings on a scale of 1 to 5 for the contractor's overall quality and satisfaction, delivery performance, satisfaction with the quality of service delivered, satisfaction with problem resolution, and satisfaction with contractor personnel. It also asks whether the respondent has issued any cure notices, show cause notices, or suspension of progress payments to the contractor in the past three years. Respondents are asked if they have terminated the contractor for default within the past three years or if any such actions are pending. The questionnaire inquires if the respondent would award the contractor another contract and asks for explanations of any ratings of 1 or 2. It requests information on discussions with the contractor regarding past performance and exercising of any contract options. The respondent is asked to provide the contract period of performance and dollar value as well as a brief description of services and any reports on adverse performance and corrective actions.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 3- Product _Price Cost Schedule.xlsx | XLSX spreadsheet | |
| Attachment 4- Pay.gov Vendor Submittal Instructions.pdf | ||
| Attachment 6- Question Submission Format.xlsx | XLSX spreadsheet | |
| 36C10G23R0003 National File Scanning Solicitation.pdf | ||
| Attachment 5 - HIPPA Business Associate Agreement.pdf | ||
| Attachment 8- QSR Reporting Tool.xlsx | XLSX spreadsheet | |
| Attachment 2- Contractor Discrepancy Report.pdf | ||
| Attachment 1 - Invoice Inquiry Tracker.xlsx | XLSX spreadsheet |
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Text version
Attachment 7 36C10G23R0003
Department of Veterans Affairs:
INFORMATION REQUEST: PAST PERFORMANCE QUESTIONNAIRE
The Department of Veterans Affairs is currently in the process of awarding a competitive enterprise wide strategic contract for Standard Manual Wheelchairs and Accessories for in home use. This Questionnaire has been sent to you for a reference for solicitation:
Send completed questionnaires to Nequa D. Godette at Nequa.Godette@va.gov and Zachary Wilcox at Zachary.Wilcox@va.gov
Please fill the subject line of the e-mail as: [Company Name] – Past Performance Questionnaire– 36C10GR0003.
NOTE TO CONTRACTORS: If the Questionnaire is provided for Subcontractor’s reference, the Contractor’s name below must include both the Prime and Subcontractor Names.
PAST PERFORMANCE QUESTIONNAIRE
Contractor’s Name:
Subcontractor’s Name (if applicable):
BPA/Contract/Task Order Number:
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.
7. 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.
8. 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.
9. Based on the contractor’s overall performance, would you award them another contract?
|_| Yes |_| No If No, please explain.
10. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? |_| Yes |_| No Please explain.
11. Do you file past performance information in a database that the Contracting Officer may search?|_| Yes |_| No Please explain.
12. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
13. What was the contract period of performance (i.e., when were services provided)?
14. What was the dollar value of the contract performed by the contractor?
15. 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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