Attachment C - PP Evaluation Questionnaire.docx

Attachment C

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FOR

RFP: 36C24822R0071

Dear Sir or Madam:

1. The Department of Veterans Affairs (VA), Network Contracting Office (NCO) 8, is currently evaluating proposals for the acquisition of reference laboratory testing for all esoteric tests from associated VISN 8 VA Medical Facilities and the transportation of clinical laboratory specimens to the contractor’s laboratory(s).

2. As part of the source selection process, potential offerors’ past performance is being evaluated. The VA would appreciate your time and effort in completing the attached questionnaire. Please return completed questionnaires to Paul Jarrett, paul.jarrett@va.gov and/or to Jose Ortiz-Velez, Jose.Ortiz-Velez@va.gov, no later than date TBD; Subject line: RFP 36C24822R0071- Contractor Past Performance.

3. Please use the rating system and definitions listed in the questionnaire to complete your Past Performance evaluation.

4. Comment freely in the spaces below the questions or on a separate sheet of paper if necessary. Both favorable and unfavorable comments are welcome.

5. The time and effort in completing this questionnaire is greatly appreciated.

Thank you in advance for your assistance.

Sincerely,

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

SOLICITATION 36C24822R0071

(Offerors may request a copy of this questionnaire as a word document in order to facilitate completion)

MESSAGE TO THE ASSESOR (Government/non-Government personnel that had experience with the offeror on a previous relevant contract): This questionnaire is provided to assist the VA in the past performance evaluation of offerors pertaining to a competitive acquisition that will result in the award of federal contracts. Therefore, it is important that your information be as factual, accurate and as complete as possible to preclude the need for follow-up queries by the evaluators. In an effort to expedite receipt of the requested information, the contracting office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed questionnaire(s) to Paul Jarrett, paul.jarrett@va.gov and/or to Jose Ortiz-Velez, Jose.Ortiz-Velez@va.gov.

PART I. CONTRACT INFORMATION (to be completed by the offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:____________________________________

Address:___________________________________________________________

Program Identification/Title:___________________________________________

Government or Non-government Contract:________________________________

Contract Number:____________________________________________________

Contract Type:_______________________________________________________

Prime Contractor Name (if different from the contractor name cited above):_______

CAGE Code:_________________________________________________________

Contract Award Date:__________________________________________________

Forecasted or Actual Contract Completion Date:_____________________________

Nature of the Contractual Effort or Items Purchased:__________________________

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE (to be completed by the offeror)

Name:_____________________________________________________________

Title:______________________________________________________________

Date:______________________________________________________________

Telephone Number:___________________________________________________

Address:____________________________________________________________

E-mail Address:______________________________________________________

PART II. EVALUATION (to be completed by the assessor)

Assessor Name:_________________________

Title:__________________________________

Phone Number:__________________________

E-mail address:__________________________

Identify your role in the contract award or administration and the period of your involvement.

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO)

Contract Specialist

Contracting Officer’s Representative (COR)

Technical Project Lead/Project Officer

Quality Assurance Specialist

Defense Contract Audit Agency (DCAA) Auditor

Other:

PART III. EVALUATION DEFINITIONS. The following definitions must be used in your assessment of contractor’s performance.

(E) Exceptional/Substantial Confidence

Performance meets contractual requirements and exceeds many (requirements) to the Government's benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

(S) Satisfactory/Satisfactory Confidence

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(M) Marginal/Limited Confidence

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

(N) Neutral/Unknown Confidence

Performance information not recent or relevant. Unable to provide assessment.

(U) Unsatisfactory/No Confidence Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor's corrective actions appear or were ineffective.

PART IV. PERFORMANCE EVALUATION.

1. What is your overall assessment of the contractor’s ability to meet the technical requirements? Please consider, as applicable, the following in your assessment:

· Laboratory Testing

· Computer Interface

· Turn Around Time (TAT)

· Customer Support Services

· Invoicing

· Transportation of Specimens

· Consultative Services

1a. Please provide rationale for the assigned rating.

1b. Did the Government contribute in any way to any of the technical problems identified in the above assessment? Please explain.

2. What is your overall assessment of the contractor’s ability to meet the schedule?

2a. Please provide rationale for the assigned rating.

2b. Did the Government contribute in any way to any of the technical problems identified in the above assessment? Please explain.

3. What is your overall assessment of the contractor’s management performance? Please consider, as applicable, the following in your assessment.

· Management Responsiveness. Timeliness, completeness, and quality of problem identification, proposal submittal, history of cooperative behavior, effective business relations, teamwork and customer satisfaction.

· Sub-contract Management. Timely award and management of sub-contracts and meeting sub-contracting goals for small business, small disadvantaged business, etc.

· Program Management. Effectiveness of integration and coordination of all activities required to execute the contract, use of resources, assignment of responsibility, internal coordination and risk management practices.

· Management of Personnel. Ability to select, retain, support, and replace personnel with the experience and expertise necessary to accomplish the Government’s requirements within schedule and budget.

3a. Please provide rationale for the assigned rating.

3b. Did the Government contribute in any way to any of the technical problems identified in the above assessment? Please explain.

4. Overall rating of contractor’s performance on contract being assessed?

5. Given the choice, would you award to this contractor again? Please expand on your answer below.

Yes:______ No:_____

General Comments:

6. Are you aware of other references that we could contact to find additional past performance information for this firm? If so, please provide any available contact information below.

Name: Phone Number:

Email:

Business: Position: