Attachment B Past Performance Questionaire fillable.pdf
PDF 460 KB Posted
- Attached to
- Q301--Genetic Testing Services for P&LMS, LR, AR Federal contract opportunity
- Solicitation number
- 36C25626Q0837
About this file
This document is a Past Performance Questionnaire template designed for federal contract evaluation purposes. Responses are due by 12:00 p.m. Central Time on Tuesday, July 7, 2026, and should be submitted via email to rene.impey@va.gov.
The questionnaire requests basic contractor information including company name, address, and point of contact, along with specific contract details necessary to assess relevancy and recency. Required contract information includes contract number, type, award date, period of performance, total dollar amount including options, and a brief description of services performed to determine scope similarity. Failure to provide this information may render a proposal unresponsive. The evaluation uses a six-point rating scale: Outstanding (O) indicating high confidence in successful performance; Excellent (E) indicating significant confidence; Satisfactory (S) indicating confidence with little doubt; Neutral (N) indicating no identifiable performance record; Marginal (M) indicating substantial doubt and potential need for process changes; and Unsatisfactory (U) indicating extreme doubt. Assessment categories include Quality of Service (five evaluation criteria), Timeliness of Performance (four criteria), Business Relations (ten criteria), and Management of Key Personnel (five criteria). Respondents are instructed to supplement their own knowledge with input from others in their organization and may provide additional comments on other contracts or programs involving the contractor. The questionnaire includes space for handwritten remarks and requires the respondent's printed name, title, signature, and phone number.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25626Q0837 0001.pdf | ||
| ATTACHMENT E Quality Assurance Surveillance Plan.docx | DOCX document | |
| ATTACHMENT D NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx | DOCX document | |
| ATTACHMENT C CONTRACTOR CERTIFICATION.docx | DOCX document | |
| 36C25626Q0837_1.docx | DOCX document | |
| ATTACHMENT A LIST OF PAST PERF REF.docx | DOCX document | |
| 36C25626Q0837.pdf |
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Text version
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 12PM CT, Tuesday, July 7, 2026
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: |
| Text9: |
| Text8: |
| Text7: |
| Text6: |
| Text5: |
| Text4: |
| Text3: |
| Text2: |
| Text1: July 7, 2026; 12:00PM |
| SCOPE 5: |
| SCOPE 4: |
| SCOPE 3: |
| SCOPE 2: |
| SCOPE 1: |
| E TOTAL CONTRACT DOLLAR AMOUNT INCLUDING: |
| Text13: Tuesday, July 7, 2026; 12:00 p.m. CT |
| Text14: rene.impey@va.gov |
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