Attachment F - Past Performance Questionnaire.docx
DOCX document 99 KB Posted
- Attached to
- Y1DA--652-24-103 Increase Surgical Access Federal contract opportunity
- Solicitation number
- 36C24626R0023
About this file
This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate contractor performance for the "Increase Surgical Access" project (652-24-103) at the Central Virginia VA Healthcare System in Richmond, Virginia. The questionnaire is to be completed by project owners or references who have direct knowledge of the contractor's past performance and should be submitted to Contracting Specialist Aaron Holmes (aaron.holmes@va.gov) and Contracting Officer Madeline Lucena-Pulst (madeline.lucena-pulst@va.gov) by the proposal due date.
The questionnaire evaluates contractors across five primary performance categories: Quality (including quality control, schedule development, submittals, workmanship, and specification compliance); Timely Performance (including schedule adherence, cure notices, proposal timeliness, and punchlist resolution); Management Effectiveness (including manager qualifications, subcontractor management, personnel hiring, decision-making authority, warranty response, and payment practices); Compliance with Safety Standards (including adequacy and implementation of safety plans); and Overall Performance. Each evaluation area uses a five-point rating scale (A=Exceptional, B=Very Good, C=Satisfactory, D=Marginal, E=Unsatisfactory, NA=Not Applicable). The questionnaire also requests narrative information regarding contractor strengths and weaknesses, willingness to award again, awareness of similar contracted efforts, and identification of additional references who should be contacted for performance evaluation.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24626R0023 0002.docx | DOCX document | |
| Photos.zip | ZIP file | |
| Pre-Bid Site Visit Agenda.pdf | ||
| 36C24626R0023 0001.docx | DOCX document | |
| Site.Visit.Log.04.09.2026.pdf | ||
| Attachment A - Drawings.pdf | ||
| Attachment K - Brand Name Justification for Hillrom_Redacted.pdf | ||
| Attachment H - Cost Breakdown by Division.xlsx | XLSX spreadsheet | |
| Attachment G - Site Visit.docx | DOCX document | |
| Attachment C - Specifications Vol 2.pdf | ||
| 36C24626R0023_2.docx | DOCX document | |
| Attachment I - Submittal Register.xlsx | XLSX spreadsheet | |
| Attachment D - Specifications Vol 3.pdf | ||
| Attachment B - Specifications Vol 1.pdf | ||
| Attachment J - 27 52 23 Nurse Call and Code Blue Systems ASI.pdf | ||
| Attachment E - Wage Determination VA20250155.pdf |
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Text version
36C24626R0028
PAST PERFORMANCE QUESTIONAIRRE REQUEST LETTER
FROM:
Contracting Specialist Aaron Holmes Network Contracting Office 6-RPO EAST 100 Emancipation Drive, Bldg. 27 Hampton, VA 23667
SUBJECT: Request for Past/Present Performance Information
1. You have been identified as a point of contact for a past and/or present performance evaluation of _________ . This firm is currently being considered for a contract at the Central Virginia VA Healthcare System located in Richmond, VA.
2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed questionnaire directly to Contract Specialist Aaron Holmes at aaron.holmes@va.gov and cc Contracting Officer Madeline Lucena-Pulst at madeline.lucena-pulst@va.gov no later than the proposal due date.
Questionnaires shall not be sent back to the Contractor. If you have any questions or concerns regarding this request, please contact Contract Specialist Aaron Holmes at aaron.holmes@va.gov and cc Contracting Officer Madeline Lucena-Pulst at madeline.lucena-pulst@va.gov.
36C24626R0023
652-24-103 | Increase Surgical Access
Past Performance Questionnaire
SECTION A.1: Contractor and Project Information (to be completed by the contractor/offeror) prior to sending to references.
A. Contractor’s name and address:
B. Project Owner -POC:
C. Phone:
D. Email Address:
D. Contract Number:
E. Project Title/Desc of Work:
F. Contract Type:
G. Project Award Date: Scheduled Completion Date:
Current/Final Completion Date:
H. Project Award Amount: Current/Final Project Amount:
I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier A.2: EVALUATED BY: (to be completed by Project Owner) (Title) / / (Phone/Fax/Email) (Signature) (Date) (Typed or Printed Name) Address:
| A = Exceptional |
| Performance meets or met contractual requirements and exceeds or exceeded many of your company’s expectations. The contractual performance reflects or reflected few |
minor problems and corrective actions taken by the contractor appear to be highly effective or corrective actions taken were effective.
| B = Very Good |
| Performance meets or met contractual requirements and exceeds or exceeded some of your company’s expectations. The contractual performance reflects or reflected some |
minor problems and corrective actions being taken by the contractor appear to be effective or corrective actions taken were effective.
| C = Satisfactory |
| Performance meets or met contractual requirements. The contractual performance reflects or reflected some minor problems. Corrective actions being taken by the |
contractor appear to be effective or corrective actions taken were effective.
| D = Marginal |
| Performance does or did not meet some contractual requirements. The contractual performance reflects or reflected serious problems(s) for which the contractor has not |
yet identified acceptable corrective actions or did not provide acceptable corrective actions.
| E = Unsatisfactory |
| Performance does or did not meet most contractual requirements and recovery is not likely or did not occur. The contractual performance contains or contained serious |
problem (s) for which the contractor’s corrective actions appear ineffective or were ineffective.
| NA = N/A |
| Not applicable or rater has not observed performance in this area. |
EVALUATION AREAS
| I. Quality |
| A |
| B |
| C |
| D |
| E |
| NA |
| 1. |
| Contractor provided effective quality control and inspection procedures that resulted in a quality- |
finished project.
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| 2. |
| Contractor developed and submitted realistic progress schedules. |
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| 3. |
| Contractor provided well researched and clearly identified submittals that matched contract requirements. |
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4.
| Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items. |
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| 5. |
| Contractor thoroughly reviewed drawings and specifications for accuracy, completeness, and |
compliance with contract requirements.
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| II. Timely Performance |
| A |
| B |
| C |
| D |
| E |
| NA |
| 1. |
| Contractor met established project schedules to complete the project on time. |
| □ |
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2.
Contractor performed all work without the issuance of a cure notice or show cause letter. (If a notice was issued, please describe the circumstances on a separate sheet of paper and identify if liquidated damages were assessed.)
| 3. |
| Contractor provided timely cost/design proposals. |
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| Contractor submitted the progress schedule and interim progress reports as required in a timely manner and the schedule was approved prior to actual construction. |
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| 5. |
| Contractor provided submittals on time as required. |
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6.
Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled
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| 7. |
| Contractor provided timely resolution of all punchlist items. |
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| III. Management Effectiveness |
| A |
| B |
| C |
| D |
| E |
| NA |
1.
Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
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| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
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3.
Contractor hired, maintained, and replaces as necessary, qualified personnel and subcontractors/suppliers.
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| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule. |
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| 5. |
| Contractor provided timely and satisfactory response to warranty issues after project completion. |
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| 6. |
| Contractor paid employees/subcontractors/suppliers as required. |
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7.
Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution.
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| IV. Compliance with Safety Standards |
| A |
| B |
| C |
| D |
| E |
| NA |
| 1. |
| Adequacy of Safety Plan |
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| 2. |
| Implementation of Safety Plan |
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| V. Overall Performance |
| A |
| B |
| C |
| D |
| E |
| NA |
| 1. |
| Please rate the contractor’s overall performance |
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Additional Information:
(1) Identify the contractor's overall strengths and weaknesses.
(2) Given the choice, would you award to this contractor again?
(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.
(If more comment space is needed, please attach pages.) Thank you for taking the time to complete this questionnaire.
652-24-103 | Increase Surgical Access image1.jpeg
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