Attachment C - Past Performance Questionnaire.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C24624R0045
About this file
This document contains a past performance questionnaire template for a federal contractor to send to references regarding corrective work on a steam distribution system. The contractor is responding to Solicitation Number 36C24624R0045 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 6 to perform Project 590-20-903, which involves correcting deficiencies in the steam distribution system at the Hampton VA Medical Center. The contractor is required to identify past customers and solicit feedback on the contractor's performance using this questionnaire template. References are asked to evaluate the contractor's performance in areas such as quality, timeliness, management effectiveness, and safety compliance. References must complete and return the questionnaire by March 22, 2024 directly to the contracting officer, omitting the contractor.
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ATTACHMENT C : PAST PERFORMANCE QUESTIONAIRE REQUEST LETTER
FROM:
[Insert Company Official Name, Title, and Company Name]
SUBJECT: Request for Past/Present Performance Information
[Insert Company Name] is currently responding to VHA Network Contracting Office 6 and Hampton VA Medical Center, regarding a request for proposal for Project 590-20-903, Correct FCA Deficiencies Steam Distribution System. This Request for proposal requires respondents to identify customers and solicit their response regarding [Insert Company Name] performance.
[Insert Company Name] is providing past performance data to VHA Network Contracting Office 6 relating to our performance on contract [Insert contract name/number] and have identified [Insert name of reference] as the point of contact for this contract.
The request for proposal instructs that respondents provide customers with the attached questionnaire. Please complete the questionnaire (Sections B and C) and return it by no later than 10:00 AM EST, March 22, 2024. DO NOT return the completed questionnaire to the respondent. Return the completed questionnaire directly to the Government Contracting Officer, Madeline Lucena-Pulst, via email at madeline.lucena-pulst@va.gov.
*Please do not return the completed form to the Contractor requesting the reference. *
Past Performance Questionnaire
SECTION A.1: Contractor and Project Information (to be completed by the contractor (offeror) prior to sending to references.
A. Contractor’s name and address: _________________________________________
B. Project Owner -POC: _________________________________________
| C. Phone: | _________________________________________ | |
| D. Email Address: | _________________________________________ |
D. Contract Number: _________________________________________ E. Project Title/Desc of Work: _________________________________________
| _________________________________________ | ||
| F. Contract Type: | _________________________________________ | |
| G. Project Award Date: ______________ | Scheduled Completion Date: ________________ |
Current/Final Completion Date: ________________
H. Project Award Amount: ____________ Current/Final Project Amount: ________________
I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier
A.2: EVALUATED BY: (to be completed by Project Owner)
(Signature) (Date)
_____________________________________ Address: _____________________________ (Typed or Printed Name) _____________________________________ (Title)
(Phone/Fax/Email)
| A |
| B |
| C |
| D |
NA
| Substantial Confidence |
| Satisfactory Confidence |
| Limited Confidence |
| No |
Confidence
Unknown Confidence
| Based on the offeror’s performance record, there is a high expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is an expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is low expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is no expectation that the offeror will successfully perform. |
No performance record is identifiable, or the offeror’s performance record is so sparse that no rating can be reasonably assigned.
EVALUATION AREAS
I. Quality A B C D NA
| 1. |
| Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project. |
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| 2. |
| Contractor developed and submitted realistic progress schedules. |
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| 3. |
| Contractor provided well researched and clearly identified submittals that matched contract requirements. |
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| 4. |
| Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items. |
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| 5. |
| Contractor thoroughly reviewed drawings and specifications for accuracy, completeness, and compliance with contract requirements. |
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II. Timely Performance A B C D NA
| 1. |
| Contractor met established project schedules to complete the project on time. |
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| 2. |
| Contractor performed all work without the issuance of a cure notice or show cause letter. (If a notice was issued, please describe the circumstances on a separate sheet of paper and identify if liquidated damages were assessed.) |
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| 3. |
| Contractor provided timely cost/design proposals. |
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| 4. |
| Contractor submitted the progress schedule and interim progress reports as required in a timely manner and the schedule was approved prior to actual construction. |
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| 5. |
| Contractor provided submittals on time as required. |
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| 6. |
| Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled |
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| 7. |
| Contractor provided timely resolution of all punchlist items. |
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III. Management Effectiveness A B C D NA
| 1. |
| Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
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| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
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| 3. |
| Contractor hired, maintained, and replaces as necessary, qualified personnel and subcontractors/suppliers. |
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| 4. |
| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule. |
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| 5. |
| Contractor provided timely and satisfactory response to warranty issues after project completion. |
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| 6. |
| Contractor paid employees/subcontractors/suppliers as required. |
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| 7. |
| Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution. |
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IV. Compliance with Safety Standards A B C D NA
| 1. |
| Adequacy of Safety Plan |
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| 2. |
| Implementation of Safety Plan |
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V. Overall Performance A B C D NA
| 1. |
| Please rate the contractor’s overall performance |
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Additional Information:
(1) Identify the contractor's overall strengths and weaknesses.
(2) Given the choice, would you award to this contractor again?
(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.
(If more comment space is needed, please attach pages.)
Thank you for taking the time to complete this questionnaire.
File details come from the government source that posted it. Updated .