Attachment 9 - 663-21-100 - Past Performance Questionnaire.docx
DOCX document 112 KB Posted
- Solicitation number
- 36C26026R0029
About this file
This is a Past Performance Questionnaire (PPQ) template designed by the VHA Network Contracting Office 20 in Vancouver, Washington, to evaluate contractor performance for Project 663-21-100, the Upgrade External Security System at Puget Sound VA Health Care System in Seattle, Washington. The form is completed in two sections: Section 1 requires the contractor being evaluated to provide contract information including the offeror's name, address, point of contact details, work performed percentage, contract title, contract number, contract type, contract location, award and acceptance dates, original and final contract prices, and project scope description with relevance to the current solicitation. Section 2 is completed by the evaluator (the client organization) and requests the evaluator's name, position, contact information, and role in the project.
The questionnaire assesses seven performance categories rated on an adjectival scale: Quality (design and construction standards compliance), Schedule/Timeliness (delivery and completion adherence), Communication (cooperativeness and responsiveness), Management/Personnel/Labor (effectiveness of leadership and personnel continuity), Cost/Financial Management (price compliance), Subcontract Management (oversight and problem resolution), and Summary (overall performance rating and rehire likelihood). Ratings are defined as Outstanding, Above Average, Satisfactory, Unsatisfactory, or Not Applicable, with detailed definitions provided to ensure consistent evaluation. The template includes space for evaluator comments on each category and an evaluator signature with date. A definitions page is included for reference during completion and is to be removed before final evaluation.
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Text version
VHA NETWORK CONTRACTING OFFICE 20 ● 1601 E. FOURTH PLAIN BLVD BLDG. 17, SUITE B428 ● VANCOUVER, WA
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 Project # 663-21-100 Upgrade External Security System at Puget Sound VA Health Care System, Seattle, WA 98108.
Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to determine the company’s ability to responsibly 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.
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 contractor 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 FOR EVALUATION PURPOSES – 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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