Attachment D - PAST PERFORMANCE SURVEY.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C24626Q0199
About this file
This document is a Past Performance Survey issued by the Department of Veterans Affairs Mid-Atlantic Healthcare Network (VISN 6) for a Patient Ceiling Lift Replacement and Installation contract. The survey is designed to gather feedback on a contractor's performance across ten key evaluation elements, including technical understanding, problem resolution, resource management, personnel skills, delivery performance, and overall contract compliance. Respondents are asked to rate each performance element on a scale from 1-6 and provide comments.
The survey is specifically related to Solicitation Number 36C24626Q0199 for Patient Ceiling Lifts at Cottage 72, with a response deadline of 9:00 a.m. EST on April 15, 2025. Respondents are requested to complete the questionnaire and email their feedback to Chellry.Whittier@va.gov, providing details such as contractor name, contract value, award dates, and contract type. The survey aims to help the VA evaluate the contractor's past performance and inform potential future contract awards for patient transfer lift equipment.
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PAST PERFORMANCE SURVEY INSTRUCTIONS
The Department of Veterans Affairs Mid-Atlantic Healthcare Network, VISN 6 is considering (Vendor) for the award of a VA contract for Patient Ceiling Lift Replacement and Installation. Your comments would be appreciated regarding this firm’s past performance. The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s).
a. Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone and fax number.
b. Include the contractor’s name and address, the title and/or description of the type of work performed the award number, the value of the contract (including options), the award and completion date of the project, and the type of award/solicitation.
c. Use the rating scale found on the bottom left corner of the questionnaire to rate each performance element.
d. Comments are encouraged and would be appreciated.
e. Please e-mail your response no later than 9:00 a.m. EST on April 15, 2025, by email to: Chellry.Whittier@va.gov.
Thank you for your time and participation.
PAST PERFORMANCE SURVEY
YOUR NAME & TITLE:
YOUR ORGANIZATIONAL ADDRESS:
TEL NO.
FAX:
E-MAIL:
CONTRACTOR’S NAME & ADDRESS
TITLE OR DESCRIPTION OF REQUIREMENT:
| CONTRACT NUMBER: |
| CONTRACT VALUE (INCLUDING OPTIONS): |
| CONTRACT TYPE (circle one): |
| CONTRACT AWARD & COMPLETION DATE: |
| PAST PERFORMANCE ELEMENT |
| RATING |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| NA |
1. The Contractor demonstrated a thorough understanding of the technical requirements of the contract/task.
Comments: VISN 16 laboratories are long time users of Stago coagulation instrumentation and reagents. All requirements of the BPAs are consistently met.
2. The Contractor anticipated/identified and resolved problems effectively.
Comments:
3. The Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.
Comments: Stago has consistently managed and supported the V16 as required.
4. The Contractor provided the necessary skilled personnel to perform the required work.
Comments:
5. The Contractor retained the necessary skilled personnel and maintained a low turnover rate.
Comments:
6. The Contractor met the scheduled contract delivery dates.
Comments:
7. The Contractor provided accurate, complete, and high- quality deliverables.
Comments:
8. The Contractor complied with the terms of the contract.
Comments:
9. The Contractor was diligent in forecasting and controlling contract the cost.
Comments:
10. I would recommend award to this contractor again.
Comments:
| 1 |
| 0 – 25% of the time |
| Strongly Disagree |
| PLEASE RETURN COMPLETED RESPONSE |
TO: Chellry Whittier E-MAIL: chellry.whittier@va.gov SUBJECT : Patient Ceiling Lift Replacement and Installation
| 2 |
| 26 – 40% of the time |
| Disagree |
| 3 |
| 41 – 55% of the time |
| Somewhat Disagree |
| 4 |
| 56 – 70% of the time |
| Somewhat Agree |
| 5 |
| 71 – 85% of the time |
| Agree |
| 6 |
| 86 – 100% of the time |
| Strongly Agree |
NA
No Knowledge of This Element
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