ATTACHMENT D.4 - PAST PERFORMANCE QUESTIONNAIRE.docx
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- Solicitation number
- 36C24925R0028
About this file
This document is a Past Performance Questionnaire for a VA contract solicitation (RFP 36C24925R0028) for Angio Interventional Radiologist Services. The questionnaire is designed to evaluate potential contractors' past performance across multiple performance dimensions, including contract compliance, personnel quality, scheduling, responsiveness, reliability, and technical direction. Evaluators are asked to rate performance using a standardized scale from Outstanding (O) to Unacceptable (U) across ten specific evaluation criteria.
The solicitation is for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9, with a performance period from 4/1/26 to 3/31/31. The past performance form requires detailed feedback from previous clients, to be submitted to the contracting specialist Laura Edelman via email by the proposal submission due date. Key aspects of the evaluation include assessing the contractor's ability to meet contract requirements, use appropriate personnel, maintain performance schedules, respond to changing needs, and provide reliable and responsive services.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT D.1 - QUALITY ASSURANCE SURVEILLANCE PLAN.pdf | ||
| ATTACHMENT D.5 - ORG CONFLICT OF INTEREST.pdf | ||
| ATTACHMENT D.2 - RULES OF BEHAVIOR.pdf | ||
| ATTACHMENT D.3 - CONTRACTOR CERTIFICATION.pdf | ||
| 36C24925R0028.docx | DOCX document |
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Text version
Attachment D.4 – Past Performance Questionnaire
RFP 36C24925R0028
PAST PERFORMANCE QUESTIONNAIRE
REFERENCE INSTRUCTIONS: The Network Contracting Office 9 is soliciting for award of a VA contract for Angio Interventional Radiologist Services. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate contractors who have provided Angio-Interventional Radiology Services in the past.
Survey must be completed by evaluator and sent to the contracting specialist, Laura Edelman via email at laura.edelman@va.gov by the proposal submission due date.
Information of Company to be Evaluated
| Company name: | ________________________________ | ||
| Address: | ________________________________ | ||
| ________________________________ | |||
| Phone: | ________________________________ | ||
| Email: | ________________________________ |
Information of Evaluating Agency
| Evaluator’s name: | ________________________________ | ||
| Title: | ________________________________ | ||
| Agency name: | ________________________________ |
Information regarding your Contract with the company to be evaluated:
| Estimated Contract Amount: | ________________________________ | |
| Contract Period of Performance: | ________________________________ | |
| Type of Services rendered: | ________________________________ |
Please evaluate the past performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.
“O” = Outstanding = Performance greatly exceeded the contract requirements
“A” = Above Average = Performance exceeded the contract requirements
“S” = Satisfactory = Performance met the contract requirements
“M” = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory
“U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements
| Please rate and provide information/comments for the following: |
| Circle one |
Q1. To what extent did the contractor comply with contract requirements?
O A S M U
Q2. If reports were required, were they accurate in meeting contract requirements?
O A S M U
Q3. To what extent did the contractor use appropriate personnel for contract requirements?
O A S M U
Q4. To what extent was contractor able to meet the performance schedule?
O A S M U
Q5. What extent was contractor flexible in responding to changing needs?
O A S M U
Q6. To what extent was the contractor reliable?
O A S M U
Q7. To what extent was the contractor responsive to technical directions?
O A S M U
Q8. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
Yes No
Q9. Would you award another contract to the party being evaluated? If no, please explain:
Yes No
Q10. To what extent did contractor notify you of problems or potential problems?
O A S M U
11. Please describe services provided under your contract, period of performance and total cost:
12. Additional Remarks:
Signature of Evaluator
Date
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