ATTACHMENT D.7 - PAST PERFORMANCE QUESTIONNAIRE.docx
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- Solicitation number
- 36C24924Q0296
About this file
This document is a Past Performance Questionnaire for a federal contract opportunity. The questionnaire is being used to evaluate the past performance of a contractor who has provided PICC Line services. The evaluator is asked to provide ratings and comments on various aspects of the contractor's performance, such as compliance with contract requirements, accuracy of reports, use of appropriate personnel, ability to meet the performance schedule, reliability, responsiveness to technical directions, and notification of problems. The evaluator is also asked to indicate whether they would award another contract to the contractor and to describe the services provided under the previous contract. The related federal contract opportunity is for PICC Line insertion services, with a period of performance from 10-01-24 to 9-30-29, under Solicitation Number 36C24924Q0296.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24924Q0296 0001.docx | DOCX document | |
| 36C24924Q0296.docx | DOCX document | |
| ATTACHMENT D.2 - RULES OF BEHAVIOR.pdf | ||
| ATTACHMENT D.4 - CANDIDATE PACKET COVER PAGE.docx | DOCX document | |
| ATTACHMENT D.1 - QUALITY ASSURANCE SURVEILLANCE PLAN.docx | DOCX document | |
| ATTACHMENT D.5 - WD 2015-4647 Rev 24 12-26-23.pdf | ||
| ATTACHMENT D.6 - POLICY, VA DIRECTIVES, HANDBOOKS.docx | DOCX document | |
| ATTACHMENT D.3 - IMMIGRATION CERTIFICATION.pdf |
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Text version
36C24924Q0296 Attachment D.7. Past Performance Questionnaire
PAST PERFORMANCE QUESTIONNAIRE
REFERENCE INSTRUCTIONS: The Network Contracting Office 9 is soliciting for award of a VA contract for PICC Line services. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate contractors who have provided PICC Line 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.
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
| Please rate and provide information/comments for the following: |
| Circle one |
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
File details come from the government source that posted it. Updated .