ATTACHMENT C_ Past Performance Questionnaire .docx
DOCX document 40 KB Posted
- Attached to
- Q201--IN4000. 1 VACO Health Units
- Solicitation number
- 36C10X23Q0146
About this file
This solicitation requests quotes for health unit services. The Department of Veterans Affairs seeks quotes from service-disabled veteran-owned small businesses, veteran-owned small businesses, small businesses, and large businesses to provide health unit services under an anticipated six-month base period contract with four one-year option periods. Quotes are due by July 1, 2023, and award will be made using a firm-fixed-price contract. The North American Industry Classification System code for this opportunity is 621999 for all other miscellaneous ambulatory health care services.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT A_PWS-Amend 2 FINAL.docx | DOCX document | |
| ATTACHMENT A_PWS-Amend 2 Tracked.docx | DOCX document | |
| ATTACHMENT B_Government Responses Amend 1 FINAL.xlsx | XLSX spreadsheet | |
| 36C10X23Q0146 0002_1.docx | DOCX document | |
| S06_36C10X23Q0146 0002 Final.docx | DOCX document | |
| ATTACHMENT A_Performance Work Statement.docx | DOCX document | |
| S02_36C10X23Q0146.docx | DOCX document | |
| 36C10X23Q0146_1.docx | DOCX document | |
| ATTACHMENT B_Questioner Template.xlsx | XLSX spreadsheet | |
| ATTACHMENT C_ Past Performance PPQs.docx | DOCX document | |
| ATTACHMENT D_Price Schedule.docx | DOCX document | |
| 36C10X23Q0146 Final.pdf | ||
| 36C10X23Q0146.docx | DOCX document | |
| ATTACHMENT A_PWS-Health Unit Final.pdf | ||
| ATTACHMENT B_Questions and Answers Template.xlsx | XLSX spreadsheet | |
| ATTACHMENT D_Price Schedule.docx | DOCX document |
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Text version
ATTACHMENT C - PAST PERFORMANCE QUESTIONNAIRE
AGENCY: Department of Veterans Affairs, Strategic Acquisition Center - Frederick
RFQ: 36C10X23Q0146
TO: Contracting Officer Anthony Zibolski
PHONE: 202-436-2671
E-M AIL: Dante.Ruiz@va.gov
INFORMATION REQUEST: PAST PERFORMANCE
The Department of Veterans Affairs is currently in the process of awarding a competitive service contract [CONTRACTOR NAME] has provided this Questionnaire to you for a reference regarding [CONTRACTOR NAME]’s record of past performance under Contract No. [CONTRACT #].
Please send completed questionnaires to Dante.Ruiz@va.gov AND Carey.Kauzlarich@va.gov.
NOTE TO RESPONDENTS: If the Questionnaire is provided for a subcontractor’s reference, the contractor’s name below must include both the subcontractor’s name and the offeror’s name who will be the prime contractor for this solicitation (e.g. contractor X, who will be a subcontractor to offeror Y for this solicitation).
Vendor’s Name:
Name of Person Completing the Evaluation:
Telephone: E-mail:
Title:
Company/Organization:
Instructions:
Please rate the vendor in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.
· Exceptional: Performance that almost always exceeds the contract performance standard or requirement
· Very Good: Performance that meets and occasionally exceeds the contract performance standard or requirement
· Satisfactory: Performance that meets the minimum contract performance standard or requirement
· Marginal: Performance occasionally does not meet minimum contract performance standard or requirement
· Unsatisfactory: Performance clearly below the contract performance standard or requirement
· Not Applicable: N/A
| Performance Areas |
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
| 1. QUALITY | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: Assess the achieved service performance relative to performance parameters required by the contract or order. |
| 2. SCHEDULE | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance). |
| 3. COST CONTROL (Not required for Fixed Price type contracts or orders) | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: Assess the Contractor’s effectiveness in forecasting, managing, and controlling contract or order cost. |
| 4. MANAGEMENT | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: Assess the integration and coordination of all activity needed to execute the contract or order, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the Contractor’s history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts. |
| 5. UTILIZATION OF SMALL BUSINESS | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: Assess compliance with all terms and conditions in the contract or order relating to Small Business participation (including FAR 52.219-8 Utilization of Small Businesses, and FAR 52.219-9 Small Business ☐Subcontracting Plan, when required). |
| 6. REGULATORY COMPLIANCE | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments: E.g failure to report in accordance with contract terms and conditions, late or nonpayment to subcontractors, trafficking violations, tax delinquency, defective cost or pricing data, terminations, suspension and debarments. Assess compliance with all terms and conditions in the contract/order relating to applicable regulations and codes, using the Evaluation Ratings Definitions. |
7. What was the contract period of performance (i.e., when were services provided)?
8. What was the dollar value of the contract performed by the vendor?
9. Provide a brief description of the services provided by the vendor for this contract.
| 10. Overall Recommendation |
| Would |
| Would Not |
| Signed |
| Given what I know today about the contractor’s ability to execute what he promised in his proposal, I _________________ award to him today given that I had a choice. | |
| ☐ | ☐ |
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