ATTACHMENT B Past Performance Questionaire fillable.pdf

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Attached to
6515--Steam Sterilizers to include equipment, turn-key installation and staff maintenance training
Solicitation number
36C25624Q0914
Issued by

About this file

This document is an Attachment B Past Performance Questionnaire related to a federal contract opportunity. The questionnaire is to be completed and returned by 10:00 AM CT on Wednesday, May 29, 2024.

The questionnaire requests information on the contractor's past performance, including quality of service, timeliness of performance, business relations, and management of key personnel. Respondents are asked to provide an assessment, using a rating scale from Outstanding to Unsatisfactory, for various aspects of the contractor's performance. Respondents are also encouraged to provide remarks concerning the contractor's overall performance.

The related federal contract opportunity is for the procurement of four new Steam Sterilizers, accessories, assembly, construction, installation, and staff maintenance training for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The solicitation number is 36C25624Q0914, and the total contract dollar amount is not specified.

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36C25624Q0914 0002.docx DOCX document
36C25624Q0914 0001.docx DOCX document
36C25624Q0914.docx DOCX document
ATTACHMENT A LIST OF PAST PERF REF.docx DOCX document

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ATTACHMENT B PAST PERFORMANCE QUESTIONNAIRE

RETURN BY

INSTRUCTIONS FOR THE

PAST PERFORMANCE QUESTIONNAIRE

FOR OFFICIAL USE ONLY

CONTRACTOR INFORMATION (Information on the Company that you are evaluating)

A. Contractor Name:

B. Contractor's Address:

C. Point of Contact:

CONTRACT INFORMATION:

IN ORDER TO DETERMINE RELEVANCY AND RECENCY, THE

FOLLOWING DATA IS REQUIRED. FAILURE TO PROVIDE THIS

INFORMANTION MAY RENDER THE PROPOSAL UNRESPONSIVE.

A. CONTRACT NUMBER:

B. CONTRACT TYPE:

C. AWARD DATE:

D. PERIOD OF PERFORMANCE:

E. TOTAL CONTRACT DOLLAR AMOUNT INCLUDING

OPTIONS, IF APPLICABLE: $________________

F. SCOPE: PLEASE INCLUDE A BRIEF DESCRIPTION OF THE

SERVICES PERFORMED TO DETERMINE SIMILARITY OF

SCOPE.

PAST PERFORMANCE QUESTIONNAIRE

ATTACHMENT B–PAST PERFORMANCE QUESTIONNAIRE

RETURN BY 10AM CT, Wed., May 29, 2024

FOR OFFICIAL USE ONLY

1. Please complete this questionnaire based on the following guidance:

a. For each question please circle one rating as defined below. Please circle "N" if you are unable to provide a rating for an area. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

Rating Definition Outstanding (O) High Confidence Based on the offeror’s performance record, no doubt exists that the offeror will successfully perform the required effort.

Excellent (E) Significant Confidence Based on the offeror’s performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

Satisfactory (S) Confidence Based on the offeror’s performance record, little doubt exists that the offeror will successfully perform the required effort.

Neutral (N) Unknown Confidence No performance record identifiable (see FAR 15.305(a)(2)(iii) and (iv)).

Marginal (M) Little Confidence Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve contract requirements.

Unsatisfactory (U) No Confidence Based on the offeror’s performance record, extreme doubt exists that the offeror will successfully perform the required effort.

b. Handwritten remarks are encouraged. Space is provided at the end of the survey. If more space is needed, please provide information of a separate sheet of paper.

c. You are urged to supplement your own knowledge of the contractor's performance with the judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other contracts/programs that your activity has with this offeror.

2. Please return completed questionnaire by e-mail to:

ATTACHMENT B PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

FOR OFFICIAL USE ONLY

QUALITY OF SERVICE

1. Contractor's compliance with contractual terms and conditions. O E S N M U

2. Quality of contractor furnished reports/deliverables. O E S N M U

3. Overall rating of contractor's commitment to providing quality service. O E S N M U

4. Contractors ability to meet standards specified for performance. O E S N M U

5. Overall rating of contractor's quality of service. O E S N M U

TIMELINESS OF PERFORMANCE

1. Contractor's ability to meet specific response times and scheduled O E S N M U time frames for completion of specific tasks.

2. Contractor's responsiveness/timeliness for providing administrative O E S N M U reports/documents required by the contract.

3. Contractor's timeliness in responding to emergency service requirements. O E S N M U

4. Overall rating of contractor's responsiveness/timeliness. O E S N M U

BUSINESS RELATIONS

1. Contractor's ability to identify problems and potential problems and O E S N M U promptly notify the Contracting Officer.

2. Contractor's ability to correct problems and prevent or mitigate potential O E S N M U problems in a timely manner.

3. Contractor's willingness to improve and correct noncompliance issues O E S N M U or concerns.

4. Extent to which the contractor has demonstrated reasonable and cooperative O E S N M U behavior.

5. Contractor's ability to use effective approaches and provide technical O E S N M U expertise and resources to solve contract problems.

6. Contractor's working relationship with the Contracting Officer, O E S N M U

ATTACHMENT B – PAST PERFORMANCE QUESTIONNAIRE

quality assurance personnel, and customers.

7. Contractor's flexibility in satisfying the requirements of its customers. O E S N M U

8. Extent to which the contractor provided prompt and courteous O E S N M U service when responding to customer complaint.

9. Overall rating of customer satisfaction. O E S N M U

10. Overall rating of business relations. O E S N M U

MANAGEMENT OF KEY PERSONNEL

1. Contractor's ability to select and retain cooperative and effective O E S N M U key personnel, such as the contract manager and quality control personnel.

2. Extent key personnel were knowledgeable about contractual O E S N M U requirements.

3. Contractor's ability to meet appropriate staffing levels with qualified O E S N M U personnel in order to provide required services.

4. Contractor's ability to effectively manage subcontracts. O E S N M U

5. Overall rating of contractor's management of key personnel. O E S N M U

REMARKS CONCERNING CONTRACTOR’S OVERALL PERFORMANCE:

RESPONDENT’S PRINTED NAME: ____________________________________________

RESPONDENT’S TITLE: _____________________________________________________

RESPONDENT’S SIGNATURE: ________________________________________________

RESPONDENT’S PHONE NUMBER: ___________________________________________

FOR OFFICIAL USE ONLY

THANK YOU FOR TAKING THE TIME TO COMPLETE AND RETURN THIS QUESTIONNAIRE!

Definition
Rating
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 1:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 2:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 3:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 4:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 5:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 6:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 7:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 8:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 9:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 10:
REMARKS CONCERNING CONTRACTORS OVERALL PERFORMANCE 11:
RESPONDENTS PRINTED NAME:
RESPONDENTS TITLE:
RESPONDENTS PHONE NUMBER:
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Text1: May 29, 2024; 10:00AM CT
SCOPE 5:
SCOPE 4:
SCOPE 3:
SCOPE 2:
SCOPE 1:
E TOTAL CONTRACT DOLLAR AMOUNT INCLUDING:
Text13: Wed., May 29, 2024; 10:00 a.m. CT
Text14: rene.impey@va.gov

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