ATTACHMENT B PAST PERFORMANCE QUESTIONNAIRE.docx

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R408--FY22: A&AS Radiology Safety Consulting Service
Solicitation number
36C24822Q0461
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PAST PERFORMANCE QUESTIONNAIRE ATTACHMENT B

RFQ 36C24822Q0461, Advisory and Assistance Services Radiology Safety Consulting

Section I is to be completed by the offeror and provide a copy to your references with instructions to complete Section II through IV and submit to the Contracting Officer prior to the offer due date/local time. Contractor shall submit a completed copy of section I with their quote.

SECTION I:

Contractor:

Contractor DUNS:

Contract Number:

Contract Title:

Rater Name:

Rater Telephone:

Rater E-Mail Address:

Rater’s Role in Relation to the Contract (program/project manager, contracting officer, major end user)

INDEX

Section I – Contractor Section II – Ratings Section III – Additional Narrative Justification Section IV – Signature of Rater Section V – Return Instructions Section VI – Rating Definitions

SECTION II-RATINGS
Select a Rating Category

Contractor Performance

1. How would you rate the quality of the contractor’s services provided?

Supporting narrative: see rating definitions

Choose an item.

2. How would you rate the contractor’s ability to control costs?

Choose an item.

3. How would you rate the contractor’s timeliness of the services provided?

Supporting narrative: see rating definitions

Choose an item.

4. How would you rate the contractor’s ability to meet special needs (such as expedited or crisis support?)

Supporting narrative: see rating definitions

Choose an item.

5. How would you rate the contractor’s ability to effectively manage, coordinate, and integrate subcontractors?

Supporting narrative: see rating definitions

Choose an item.

6. How would you rate the contractor’s communication with the COR and Program Manager?

Supporting narrative: see rating definitions

Choose an item.

7. How would you rate the performance of the contractor’s warranty/maintenance?

Supporting narrative: see rating definitions

Choose an item.

8. How would you rate your overall satisfaction with the contractor’s performance?

Choose an item.

SECTION III – Additional Supporting Narrative, if required.

Include the number of the question above to which this supporting narrative applies.

SECTION IV – Signature of Rater

Rater Name:

Signature of rater: _______________________________________ Date: __________________________________________________ Signature of rater is not required if sent via e-mail directly from rater.

SECTION V – Return Instructions

Return the completed questionnaire via e-mail to rohan.mckenzie@va.gov no later than 16:00, February 28, 2022 EASTERN STANDARD TIME (EST).

SECTION VI – Rating Definitions

Rating
Definition
Note

Exceptional (E)

Performance met contractual requirements and exceeded many to the government’s benefit. The contractual performance of the element or sub element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
To justify an “exceptional” rating, identify multiple significant events and state how they were of benefit to the government. A singular benefit, however, could be of such magnitude that it alone merits an “exceptional” rating. Also, there should have been no significant weaknesses identified.

Very Good

(VG)

Performance met contractual requirements and exceeded some to the government’s benefit. The contractual performance of the element or sub element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
To justify a “very good” rating, identify a significant event and state how it was a benefit to the government. There should have been no significant weaknesses identified.

Satisfactory (S)

Performance met contractual requirements. The contractual performance of the element or sub element contained some minor problems for which corrective actions taken by the contractor appeared to be or were satisfactory.
To justify a “satisfactory” rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been no significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than “satisfactory” solely for not performing beyond the requirements of the contract/order.

Marginal (M)

Performance did not meet some contractual requirements. The contractual performance of the element or sub element being evaluated reflected a serious problem for which the contractor did not identify corrective actions. The contractor’s proposed actions were only marginally effective or were not fully implemented.
To justify a “marginal” performance rating, identify a significant event in each category that the contractor had trouble overcoming and state how it affected the government. A “marginal” rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

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