ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 25 KB Posted
- Attached to
- ELEVATOR & DUMBWAITER MAINTENANCE Federal contract opportunity
- Solicitation number
- 36C25221Q0004
About this file
This document contains a past performance questionnaire for contractors bidding on an elevator maintenance services contract. The incumbent contractor is required to provide the questionnaire to previous customers to evaluate past performance on elevator maintenance. The William S. Middleton VA Hospital in Madison, WI seeks to award a contract for elevator and dumbwaiter maintenance. The past performance questionnaire requests assessments of the contractor's quality, timeliness, customer satisfaction, management, cost, safety, and overall performance on previous contracts. Assessors are to rate the contractor's performance in these categories as exceptional, good, satisfactory, marginal, or unsatisfactory. Assessors must complete and return the questionnaire electronically to the VA contracting office by August 25, 2020. The solicitation number for the elevator maintenance services contract is 36C25221Q0004.
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| File | Type | Posted |
|---|---|---|
| ATTACHMENT A DOL WD 15-4898 REV-12 6.23.20.docx | DOCX document | |
| S02 36C25221Q0004_1.pdf |
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ATTACHMENT B: PAST PERFORMANCE QUESTIONNAIRE
SUBJECT: Past Performance Questionnaire for William S. Middleton VA Hospital Elevator Maintenance Service
PAST PERFORMANCE INSTRUCTIONS
The NCO 12 Network Contracting Activity, Milwaukee, Wisconsin has issued a solicitation to provide Elevator Maintenance Services at the William S. Middleton VA Hospital, 2500 Overlook Terrace, Madison, WI 53705.
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 12 Network Contracting Activity.
The Offeror must provide this entire document to each of its assessors. The Offeror shall only submit with its proposal (by the closing date of the Solicitation) copies of Section A of the questionnaire as provided to the assessors.
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 August 25, 2020 by Noon local time. Assessor is requested to send electronically to susan.pasholk@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.
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 |
| 36C25221Q0004 |
| Project/Requirement |
| Madison VAH Elevator Maintenance Service |
| Customer/Agency |
| Department of the Veteran Affairs, NCO 12, Milwaukee, WI 53214 |
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 provided under contract: ________________________________________________________________________
6. Contract award date: ___________ Contract Amount: Initial ___________ Final ____________
7. Period of Performance or Delivery Date: _________________________
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
8. Authorization is hereby granted to provide the information requested in this questionnaire to NCO 12 Network Contracting Activity, Milwaukee, WI.
(Signature)
| _____________________________________________ | __________________________ | |
| (Name and Title of Authorizing Official) | (Date) |
SECTION B: Assessors Information (to be completed by assessors.)
RATING SCALE Definitions
| Exceptional (E) |
| The Offeror exceeded the majority of our expectations or requirements and met all other expectations or requirements. |
| Good (G) |
| The Offeror exceeded some of our expectations or requirements and met all other expectations or requirements. |
| Satisfactory (S) |
| The Offeror met all of our expectations or requirements. |
| Marginal (M) |
| The Offeror failed to meet some of our expectations or requirements. |
| Unsatisfactory (U) |
| The Offeror failed to meet most of our expectations or requirements. |
| Neutral / Not Applicable or Unknown (N) |
| No performance record identifiable within the area of evaluation. |
The questions in 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.
1. QUALITY:
| Overall quality of services provided |
| E |
| G |
| S |
| M |
| U |
| N |
| Quality of contractor technicians |
| E |
| G |
| S |
| M |
| U |
| N |
| Quality of contractor support staff |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to meet quality standards specified for technical performance |
| E |
| G |
| S |
| M |
| U |
| N |
| Timeliness/effectiveness of contract problem resolution without extensive customer guidance |
| E |
| G |
| S |
| M |
| U |
| N |
| Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) |
| E |
| G |
| S |
| M |
| U |
| N |
2. SCHEDULE/TIMELINESS OF PERFORMANCE:
| Compliance with requirement schedules |
| E |
| G |
| S |
| M |
| U |
| N |
3. CUSTOMER SATISFACTION:
| Contractor was reasonable and cooperative in dealing with your customers and staff |
| E |
| G |
| S |
| M |
| U |
| N |
| Professionalism of contractor |
| E |
| G |
| S |
| M |
| U |
| N |
| Overall customer satisfaction |
| E |
| G |
| S |
| M |
| U |
| N |
4. MANAGEMENT/ PERSONNEL/LABOR
| Management effectiveness |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to hire, apply, and retain a qualified workforce to this effort |
| E |
| G |
| S |
| M |
| U |
| N |
| Knowledge/expertise demonstrated by contractor personnel |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes |
| E |
| G |
| S |
| M |
| U |
| N |
5. COST/FINANCIAL MANAGEMENT
| Ability to meet the terms and conditions within the contractually agreed price(s) |
| E |
| G |
| S |
| M |
| U |
| N |
Have there been any indications that the contractor has had any financial problems? If yes, please explain below.
Yes
No
6. SAFETY/SECURITY
| Contractor’s ability to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues |
| E |
| G |
| S |
| M |
| U |
| N |
| Contractor compliance with all security requirements. |
| E |
| G |
| S |
| M |
| U |
| N |
7. GENERAL
| Compliance with contractual terms/provisions (explain if specific issues) |
| E |
| G |
| S |
| M |
| U |
| N |
Would you hire or work with this firm again? (If no, please explain below)
Yes
No
| In summary, provide an overall rating for the work performed by this contractor. |
| E |
| G |
| S |
| M |
| U |
| N |
Please provide straightforward responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (attach additional pages if necessary):
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) | (Organization) |
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