Attachment D - Past Performance.pdf
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- Solicitation number
- 36C25023Q0009
About this file
This document contains a past performance survey template and information about a related federal contract opportunity. The past performance survey template is to be used to evaluate an offeror's performance on previous contracts and includes questions rating compliance, reporting, personnel use, technical expertise, schedule adherence, flexibility, reliability, responsiveness, and problem notification. It requests identifying information about the contract and evaluator as well as optional comments.
The related federal contract opportunity is a request for quotation issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 to obtain the services of a Diagnostic Medical Physicist and Radiation Safety Officer. The solicitation number, title, opportunity type, and issuing agency are provided.
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PAST PERFORMANCE SURVEY
Offeror’s Name: ___________________________________________________
Contract Number: __________________________________________________
Contract Type and Dollar Value: _______________________________________
Brief Description of Work: _____________________________________________________________________
“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 and detailed comments for the following:
Circle one
1. To what extent did the contractor comply with contract requirements? O A S M U
2. If reports were required, were they accurate in meeting contract requirements?
O A S M U
3. To what extent did the contractor use appropriate personnel for contract requirements?
O A S M U
4. To what extent did the contractor display technical expertise? O A S M U
5. To what extent was contractor able to meet the performance schedule? O A S M U
6. To what extent was contractor flexible in responding to changing needs? O A S M U
7. To what extent was the contractor reliable? O A S M U
8. To what extent was the contractor responsive to technical directions? O A S M U
9. To what extent did contractor notify you of problems or potential problems?
O A S M U
Additional Comments:
Name of Evaluator: ____________________________
Signature of Evaluator: _________________________
Title: _______________________________________
Company: ___________________________________
Telephone No.: _______________________________
Date: ________________
10. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
O A S M U
11. Would you award another contract to the party being evaluated? If no, please explain:
O A S M U
12. Was the customer satisfied with the end product? If no, please explain: O A S M U
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