Attachment 7 - Past Performance Questionnaire.docx
DOCX document 21 KB Posted
- Solicitation number
- 36C79123R0001
About this file
This document contains a past performance questionnaire template for a federal solicitation. The solicitation is for CRT repair services with responses due to Susan Dela Cruz at the Department of Veterans Affairs by the specified date. Offerors are asked to provide references that will receive this questionnaire to evaluate the offeror's past performance on seven criteria using adjectival ratings. References are also prompted to include any additional comments and are assured their names will remain confidential. The related federal contract opportunity is for wheeled mobility repair services to be awarded by the Veterans Health Administration VISN 19 over a five year base period and four option years.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Past Performance Questionnaire
The following Offeror has submitted a proposal for Solicitation Number 36C79123R0001 - CRT Repair Services and has referenced your company in their past performance. Please provide information on the past performance of the offeror under evaluation by completing this document and returning to the Contracting team.
| Solicitation Number |
| 36C79123R0001 |
Name of Offeror under Evaluation
Submit document by email to: Susan Dela Cruz at Susan.Delacruz@va.gov.
Subject Line should read as: Solicitation #, Past Performance Questionnaire Describe the nature of your contract with the referenced Vendor (If more space is needed, please use the (“Additional Comments” block on the second page) Company/Organization Providing Reference
Company Representative Completing Questionnaire
Company Representative Email
Company Representative Phone Number
Contract Description the Offeror was Awarded
Contract Number or Project ID
Period of Performance
Contract Award Amount
What was the role of Offeror? Prime or Subcontractor?
Complete the following questions, by marking the adjectival ratings and providing comments in which there was substantial confidence or no confidence in performance.
PLEASE NOTE: In accordance with Federal Acquisition Regulations, contractors may be advised of adverse remarks and given an opportunity to respond. However, the contracting officer will not provide your name or copies of this questionnaire to the contractor or any other party not directly involved in the evaluation of the contractor’s proposal.
ADJECTIVAL RATINGS DEFINITIONS
Substantial Confidence
(SUBC)
Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.
Satisfactory Confidence
(SATC)
Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.
Limited Confidence
(LC)
Based on the offeror’s recent/relevant performance record, the Government has a low expectation the offeror will successfully perform the required effort.
No Confidence
(NC)
Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.
Unknown Confidence/Neutral
(UC)
No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.
| PAST PERFORMANCE |
| ADJECTIVAL RATINGS |
| 1. How well were the contract requirements met in compliance with contractual terms and conditions? Compliance of technical data/report preparation terms? |
| SUBC |
SATC
| LC |
| NC |
| UC |
Comments:
| 2. To what extent did the contractor adhere to the Performance schedule? Quality Control? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 3. How responsive was the contractor in resolving quality, schedule, or other contract issues? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 4. How effective was the contractor in addressing unforeseen or unusual customer needs and issues? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
5. How well was the contractor in ability to meet quality standards for technical performance?
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
6a. If you represent a government agency, and the contract included a small business subcontracting plan, how well did the contractor adhere to the plan requirements?
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6b. If you represent a government agency, and the Contract included a small business subcontracting plan, how was performance against subcontract goals? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6c. If you represent a government agency, and the contract included a small business subcontracting plan, how was compliance with subcontracting plan in general? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
| 6d. If you represent a government agency, and the contract included a small business subcontracting plan, was there timely eSRS reporting? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
| 7. How satisfied were you with the contractor’s overall performance? |
| SUBC |
| SATC |
| LC |
| NC |
| UC |
Comments:
Additional Comments:
Thank you for your response.
File details come from the government source that posted it. Updated .