ATTACHMENT 7 _ Past Performance Questionnaire.pdf

The Department of Veterans Affairs

National Acquisition Center, Commodities and Services Acquisition Service/Denver Logistics Center

ATTACHMENT 7 – PAST PERFORMANCE QUESTIONNAIRE

This information will be provided to the U.S. Department of Veterans Affairs, for use in selecting contractor(s) to provide assistive listening devices for Solicitation # 36C79126R0003 – HAPA Commercial Requirements.

This information must be submitted no later than the date of receipt of proposals as stated in Block 8 of the SF-1449. It is the offeror’s responsibility to ensure each questionnaire is distributed timely and ensures that the company providing past performance information submits the completed form on time. IT IS THE

RESPONSIBILITY OF THE COMPANY FILLING OUT FORM TO SUBMIT.

Completed forms shall be submitted by email to: Bradley Geghan, bradley.geghan@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)

Solicitation Number 36C79126R0003 Contractor’s Name your Evaluated Company/Organization Providing Reference

Company Representative Title Completing Questionnaire

Company Representative Email Company Representative Phone Number

Description of the Scope and complexity of Contract

Contract Number or Project ID Location of Contract Performance Period of Performance Awarded Amount to Contractor What was the role of Contractor your evaluating? Prime or Subcontractor? Percentage of contract completed?

mailto:bradley.geghan@va.gov

Complete the following questions, by marking the adjectival ratings and providing comments in which there were significant discrepancies or excellent 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

“E” Excellent: Performance meets contractual requirements and exceeds the

Government’s expectations. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

(HIGH CONFIDENCE)

“VS” Very Good: Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. (SIGNIFICANT

CONFIDENCE)

“S” Satisfactory: Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective action taken by the contractor was satisfactory. (CONFIDENCE)

“M” Marginal: Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

(LITTLE CONFIDENCE)

“U” Unsatisfactory: Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective. (NO CONFIDENCE)

“N” Neutral: No relevant past performance record is identifiable upon which to base a meaningful performance risk prediction. A search was unable to identify any relevant past performance information for the contractor or their key personnel.

(This is neither a negative nor positive assessment.).

PAST PERFORMANCE ADJECTIVAL RATINGS

1. How well were the contract requirements met in compliance with contractual terms and conditions?

E VS S M U N

Comments:

2. To what extent did the contractor adhere to the Performance schedule? Quality Control?

3. How responsive was the contractor in resolving quality, schedule, or other contract

E VS S M U N

issues?

Comments:

4. How effective was the contractor in addressing unforeseen or unusual customer

E VS S M U N

needs and issues?

Comments:

5a. If you represent a government agency, and the contract included a small business subcontracting plan, how was performance against subcontract goals?

5b. If you represent a government agency, and the contract included a small business subcontracting plan, how was compliance with subcontracting plan in general?

E VS S M U N

5c. If you represent a government agency, and the contract included a small business subcontracting plan, was there timely eSRS reporting?

E VS S M U N

Comments:

6. How satisfied were you with the contractor’s overall performance?

Describe the Following:

1.) Scope of Contract 2.) Complexity of Contract 3.) Contract Type 4.) Size 5.) Schedule (Corrective Action)

Signature of the evaluator

Thank you for your response.

ATTACHMENT 7 – PAST PERFORMANCE QUESTIONNAIRE