ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 20 KB Posted
- Attached to
- VISN 23 IDIQ VISN Project Support Services Solicitation Notice Federal contract opportunity
- Solicitation number
- 36C26324R0077
About this file
This document is the Past Performance Questionnaire, which is an attachment to a federal contract opportunity. The Past Performance Questionnaire is to be completed by reference contacts for a contractor that has submitted an offer for a U.S. Department of Veterans Affairs contract.
The questionnaire asks the reference contact to evaluate the contractor's performance on metrics such as providing qualified personnel, management oversight, quality of work, responsiveness to changes, and timely resolution of issues. The reference is also asked to provide details on the number of personnel needed, hired, and any turnover, as well as whether the contractor was ever issued any letters of concern. The reference is requested to return the completed form to the Contracting Officer/Contract Specialist via email by the proposal due date.
The related federal contract opportunity is for VISN 23 Project Support Services, which is a Service-Disabled Veteran Owned Small Business (SDVOSB) set-aside Request for Proposal (RFP) issued by the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 23.
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Text version
ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE
INSTRUCTIONS TO CONTRACTOR
Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions.
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement and has sent this form to you for a past performance contract reference. Please complete this form in full (all areas shaded in light yellow). Once completed, please send the form to the Contracting Officer / Contract Specialist via email: Michael.Casper@va.gov/Jeffrey.Brown8@va.gov
Department of Veterans Affairs – NCO23 ATTN: Jeffrey Brown, Reference: RFP 36C26324R0077 Email Address: Jeffrey.Brown8@va.gov
Please return the completed form no later than the date and time set for receipt of Proposals. If you have any questions, please contact Jeffrey Brown via email. Thank you for your assistance in this matter.
GENERAL INFORMATION [completed by Contractor/Offeror]
Contractor Company Name
Street Address
Contractor Point of Contact Name
City
Point of Contact Phone Number
State
Reference Project / Contract Title
Zip Code
Contract Period of Performance (start to finish):
Contract Number
Contract Dollar Value
Detailed Description of Work Performed
| Role of Contractor on This Project (check appropriate box) |
| ☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel |
RESPONDENT INFORMATION [completed by Reference Contact]
Company Name
Street Address
POC Name
City
Phone Number
State
Fax Number
Zip Code
PERFORMANCE INFORMATION – Table 1: Choose the number on the scale of 1 to 4 that most accurately describes the contractor’s performance.
PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY NEGATIVE RATING(S) in the Remarks section, below (text box will expand to whatever extent is necessary). Please provide a narrative explanation for any Ratings of 1 or 2 in the Remarks section below.
| 1 |
| 2 |
| 3 |
| 4 |
| UNSATISFACTORY |
| MARGINAL |
| SATISFACTORY |
| VERY GOOD |
| Most of the time, contractor did not meet this metric. |
| Some of the time, contractor met this metric. |
| Most of the time, contractor met this metric. |
| Nearly all of the time, contractor met this metric. |
| # |
| Contractor Reference: |
| 1 |
| 2 |
| 3 |
| 4 |
| 1. | |||
| Contractor provided experienced personnel with the technical and administrative abilities needed to meet contract/project requirements? | |||
| ☐ | ☐ | ☐ | ☐ |
| 2. | |||
| Contractor hired and if necessary, replaced, qualified personnel during the contract period in accordance with contract requirements? | |||
| ☐ | ☐ | ☐ | ☐ |
| 3. | |||
| Contractor provided Management Oversight for supervisory roles, information dissemination to employees, Government, training, timely onboarding, task completion tracking, and addressing performance issues? | |||
| ☐ | ☐ | ☐ | ☐ |
| 4. | |||
| Were contractor personnel timely and responsive in submitting documents for the background check? | |||
| ☐ | ☐ | ☐ | ☐ |
| 5. | |||
| The Contractor’s personnel’s submitted Quality work, advice, and documents? | |||
| ☐ | ☐ | ☐ | ☐ |
| 6. | |||
| Contractor provided timely resolution of contract discrepancies? | |||
| ☐ | ☐ | ☐ | ☐ |
| 7. | |||
| Contractor identified problems as they occurred? | |||
| ☐ | ☐ | ☐ | ☐ |
| 8. | |||
| Contractor suggested alternative approaches to problems? | |||
| ☐ | ☐ | ☐ | ☐ |
| 9. | |||
| Contractor displayed initiative to solve problems? | |||
| ☐ | ☐ | ☐ | ☐ |
| 10. | |||
| Contractor was responsive to contract/project changes and modifications? | |||
| ☐ | ☐ | ☐ | ☐ |
| 11. | |||
| Contractor provided adequate contract/project supervision? | |||
| ☐ | ☐ | ☐ | ☐ |
| 12. | |||
| Contractor paid subcontractors/suppliers/employees in a timely manner? | |||
| ☐ | ☐ | ☐ | ☐ |
| 13. | |||
| Contractor cooperated with Government personnel after award? | |||
| ☐ | ☐ | ☐ | ☐ |
| 14. | |||
| How would you rate the contractor's overall performance? | |||
| ☐ | ☐ | ☐ | ☐ |
PERFORMANCE INFORMATION – Table 2: Please answer the following questions regarding personnel.
Please provide any comments, narratives, or explanations on personnel below in the Remarks section (text box will expand to whatever extent is necessary).
| # |
| Questions Regarding Personnel |
| Response |
| 1. |
| Number of positions needed to be filled under your requirement/project? |
| 4. |
| Number of Resumes presented for review on contract/project? |
| 5. |
| After resume review(s), number of personnel hired and accepted under this contract/project? |
| 6. |
| After acceptance, how many personnel left before the contract ended (turnover)? |
| 7. |
| Average number of days to fill replacement personnel? |
8.
Was the contractor ever issued a letter of concern, cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
| 9. |
| Would you award another contract to this contractor? If not, please explain in “remarks.” |
REMARKS (Please use as much space as is needed – the box will expand as you type).
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