ATTACHMENT C_ Past Performance Template.docx

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Attached to
7830--VACO Fitness Center
Solicitation number
36C10X23Q0104
Issued by

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This document includes a past performance questionnaire template and details of a federal contract solicitation. The solicitation is for fitness center services at the Department of Veterans Affairs and has a NAICS code of 713940. The anticipated period of performance is a six-month base period from July 1, 2023 through December 31, 2023 with four 12-month option periods. The contract will be a firm-fixed price contract awarded through a tiered evaluation with priority given to SDVOSB, VOSB, small business and then large business concerns. Interested offerors must provide quotes responding to the performance work statement, questionnaire template and past performance template by the response date.

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File Type Posted
S02_ATTACHMENT B_Questions and Answers Template Amend 1.xlsx XLSX spreadsheet
36C10X23Q0104 Amend 1 FINAL.docx DOCX document
P09_PWS_ fitness center Amend 1 FINAL.docx DOCX document
36C10X23Q0104 Amend 1 Tracked.docx DOCX document
36C10X23Q0104 0001_1.docx DOCX document
P09_PWS_ fitness center Tracked.docx DOCX document
S06_36C10X23Q0104 0001.docx DOCX document
Attachment D_ PRICE COST SCHEDULE.docx DOCX document
S02_36C10X23Q0104 final.docx DOCX document
ATTACHMENT B_Questions and Answers Template.xlsx XLSX spreadsheet
ATTACHMENT A- PWS.docx DOCX document
36C10X23Q0104.docx DOCX document
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ATTACHMENT C. 3: PAST PERFORMANCE QUESTIONAIRRE (PPQ)

Past Performance Questionnaire Department of Veterans Affairs: RFQ# 36C10X23Q0104

E-MAIL TO: Dante E. Ruiz, Contract SpecialistAGENCY: Veterans Affairs (VA)
E-MAIL: Dante.Ruiz@va.govPHONE: 202-436-2671

-and-

E-MAIL TO: Carey M. Kauzlarich, Contracting OfficerAGENCY: Veterans Affairs (VA)
E-MAIL: Carey.Kauzlarich@va.govPHONE: 202-740-6280

INFORMATION REQUEST: PAST PERFORMANCE

This office is currently in the process of awarding a competitive task order. [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR NAME]’s record of past performance under Contract No. [CONTRACT NO.].

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Quoter’s Name:

Request for Quote: 36C10X23Q0104, OA Office of Administration

Name of Person Completing the Evaluation:

Telephone:E-mail:
Title:Company/Organization:

Please rate the quoter in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.

· Not Applicable: N/A

· 1: Performance clearly below the contract performance standard or requirement

· 2:Performance occasionally does not meet minimum contract performance standard or requirement
· 3:Performance that meets the minimum contract performance standard or requirement
· 4:Performance that meets and occasionally exceeds the contract performance standard or requirement
· 5:Performance that almost always exceeds the contract performance standard or requirement
1. Overall quality/satisfaction
N/A |_|
1 |_|
2 |_|
3 |_|
4 |_|
5 |_|

Overall satisfaction with the quoter’s performance. Would you (the reference) choose to work with this quoter again? (Additional Comments Here)

2. Delivery performance
N/A |_|
1 |_|
2 |_|
3 |_|
4 |_|
5 |_|

Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions. (Additional Comments Here)

3. Satisfaction with the quality of service delivered
N/A |_|
1 |_|
2 |_|
3 |_|
4 |_|
5 |_|

Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those. (Additional Comments Here)

4. Satisfaction with problem resolution
N/A |_|
1 |_|
2 |_|
3 |_|
4 |_|
5 |_|

This includes the quoter’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions. (Additional Comments Here)

5. Satisfaction with the quality of contractor personnel
N/A |_|
1 |_|
2 |_|
3 |_|
4 |_|
5 |_|

Rate the quality of the contractor’s staff in executing the project work scope. (Additional Comments Here)

1. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years? |_| Yes |_| No If Yes, please explain.

1. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions? |_| Yes |_| No If Yes, please explain.

1. Based on the quoter’s overall performance, would you award them another contract? |_| Yes |_| No If No, please explain.

1. Have you discussed any adverse past performance problems with the quoter and given them an opportunity to comment? |_| Yes |_| No Please explain.

1. Do you file past performance information in a database that the Contracting Officer may search? |_| Yes |_| No Please explain.

1. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.

1. What was the contract period of performance (i.e., when were services provided)?

1. What was the dollar value of the contract performed by the quoter?

1. Provide a brief description of the services provided by the quoter for this contract.

Please attach any past performance database reports or other material you deem appropriate to a full understanding of the quoter’s past performance by the evaluator.

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