ATTACHMENT 8 Past Performance Questionnaire_614-17-113.pdf.pdf

PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire for Project # 614-17-113 – Renovate Bldg. 1 Primary Care, at the Lt. Col. Luke Weathers, Jr VA Medical Center, Memphis, TN.

PAST PERFORMANCE INSTRUCTIONS

The NCO 9 Network Contracting Activity has issued a solicitation for Project 614-17-113 – Renovate Bldg. 1 Primary Care.

Past performance information will be used to evaluate proposals received. Section A is to be completed by the Offeror. Section A of the enclosed questionnaire lists the contractor who has identified your office as a source to evaluate their past performance. Section A also authorizes release of this information to NCO 9 Network Contracting Activity.

The Offeror must provide this entire document to each of its assessors. The Assessor shall only submit past performance questionnaires directly to the Contract Specialist – Matthew Whisman by way of email at matthew.whisman@va.gov.

Section B in its entirety is to be completed by the assessor(s). An individual assessor knowledgeable of the contractor’s quality of supplies and services rendered is requested to verify, complete the questionnaire, and submit to the Contracting Office. If evaluating more than one contract for the same contractor, use a separate questionnaire for each contract being evaluated.

Because this information is critical to the evaluation process, your time and effort in providing your assessment is greatly appreciated. The questionnaire should be completed as soon as possible but not later than July 31, 2026, at 2:00 PM EST. Assessor is requested to send electronically to (matthew.whisman@va.gov). Assessor: Please do not send this information to the Offeror being evaluated.

Thank you in advance for your cooperation and expeditious response to this request.

Procurement Sensitive Do Not Disclose --- See FAR Subparts 2.101 and 3.104-4 FOR OFFICIAL

USE ONLY

USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to assessors)

Solicitation Number 36C24926R0037 Project/Requirement Project 614-17-113 Customer/Agency Lt. Col. Luke Weathers, Jr VAMC, Memphis, TN.

1. Prospective Government Contractor’s Name and Address

2. Contractor Point of Contact:

3. Phone Number (with area code):

4. Assessor Contract Award Number:

5. Description of Services:

6. Contract Award Date: _______________ Contract Amount: Initial ___________ Final___________

7. Period of Performance:

ASSESSOR INFORMATION:

Assessor Name Title Phone Number/Email Address

8. Authorization is hereby granted to provide the information requested in this questionnaire to NCO 9 Network Contracting Activity, Murfreesboro, Tennessee.

Signature

Name and Title of Authorizing Official Date

SECTION B: Assessors Information (to be completed by assessors).

USE ONLY

RATING SCALE Definitions

Past performance Evaluation Ratings Rating Description ACCEPTABLE Based on the Offeror's performance record, the

Government has a reasonable expectation that the offeror will successfully perform the required effort, or the Offeror's performance record is unknown. (See note below.)

UNACCEPTABLE Based on the Offeror's performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.

QUALITY OF SERVICE

1. Rate the contractor's compliance with contractual requirements.

ACCEPTABLE_______ UNACCEPTABLE_______

2. Overall rating of contractor quality of service.

ACCEPTABLE_______ UNACCEPTABLE_______

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

SCHEDULE

3. Delivery of service was within required time period specified by contract requirements.

ACCEPTABLE_______ UNACCEPTABLE_______

USE ONLY

4. Rate the contractor's ability to control cost and submit invoices.

Are invoices complete, accurate, and timely?

ACCEPTABLE_______ UNACCEPTABLE_______

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

BUSINESS RELATIONS

5. Overall rating of contractor's business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems, etc.)

ACCEPTABLE_______ UNACCEPTABLE_______

6. Rate the working relationship between contractor's management, and your company (i.e. contractor's history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer).

ACCEPTABLE_______ UNACCEPTABLE_______

7. Rate the contractor's ability to submit required reports and/or invoices in a timely manner.

ACCEPTABLE_______ UNACCEPTABLE_______

8. Rate the contractor's responsiveness to customer complaint resolution.

ACCEPTABLE_______ UNACCEPTABLE_______

9. Overall rating of contractor's business relations.

ACCEPTABLE_______ UNACCEPTABLE_______

USE ONLY

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

How would you feel about awarding another contract to this contractor?

__________ Would not hesitate to award another contract to this contractor.

__________ Would most likely award another contract to this contractor.

__________ Would think twice about awarding another contract to this contractor but would do so if no better alternative existed.

__________ Do not wish to award another contact to this contractor.

__________ Would not award another contract to this contractor.

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

USE ONLY

Overall rating of contractor's performance (quality, schedule, business relations,) on contract being assessed.

ACCEPTABLE UNACCEPTABLE

VII. General Comments:

ASSESSOR:

Identify your role in the contract award or administration and the period of your involvement.

ROLE PERIOD OF INVOLVEMENT

Contract Specialist/Contracting Officer Technical Project Lead/Project Officer

OTHERS

(Signature) (Date)

(Typed or Printed Name) (Organization Name)

(Phone Number)