ATTACHMENT F_PAST PERFORMANCE QUESTIONNAIRE_NX EQ Cart Washer Disinfector Units.docx
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- Solicitation number
- 36C10X26R0015
About this file
This is a Past Performance Questionnaire template designed for the Department of Veterans Affairs Strategic Acquisition Center to evaluate offerors responding to Solicitation No. 36C10G26R0015 for cart and utensil washer disinfector units. Offerors must provide a maximum of three references from the past three years, and the questionnaire must be completed by each reference organization and submitted to Alanna.Wilson@va.gov and Anthony.Zibolski@va.gov with the solicitation number in the email subject line.
The questionnaire requires references to rate offerors across four evaluation categories using a three-point scale: Quality of Service (compliance with contract requirements, accuracy of reports and deliverables, technical excellence); Cost Control (effectiveness in cost management, proper invoice submission and documentation); Timeliness of Performance (meeting milestones, reliability, responsiveness to technical direction); and Business Relations (effective contract management, cooperative behavior, responsiveness to inquiries and problem resolution). References must also provide an overall satisfaction rating indicating whether they would work with the offeror again. The form requests background information on the contract including period of performance, total contract value, options exercised, and any show cause orders, stop work orders, or terminations issued. Comments from references are requested for each rating category to support evaluation decisions.
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SOLICITATION NO.: 36C10G26R0015
DESCRIPTION: Cart and Utensil Washer Disinfector Units
Attachment F Past Performance Questionnaire
SOLICITATION NO.: 36C10G26R0015
DESCRIPTION: Cart and Utensil Washer Disinfector Units
Offerors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of 3 References from Past Three Years)
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
E-MAIL completed form to: Alanna.Wilson@va.gov and Anthony.Zibolski@va.gov, ensuring that the email subject line includes “36C10G26R0015”
VA SAC is currently in the process of awarding a contract for the solicitation described above. The Offeror identified below has provided your organization’s name as a reference under the contract described below:
| Offeror Name: |
| (Insert Offeror’s Name Here) |
| Contract Number: |
| (Insert Applicable Contract Number Here) |
Please rate the Offeror in each of the categories on this questionnaire. See “Rating Guidelines” section for detailed description of categories and ratings. There is room for comments where you deem remarks would be helpful to our evaluation (see ‘Comment from Reference’ under “Offeror Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this Offeror’s past performance. Thank you for your organization’s assistance in fairly evaluating Offeror proposals for this solicitation.
| Name of Reference: |
| (Reference Complete These Sections) |
Title of Reference:
Phone Number:
E-Mail Address:
Name of Organization:
Contract Period of Performance (Month/Day/Year Begin and End):
Total Contract Value (Base and All Option Years):
Options Exercised on Contract (Yes/No)?
Brief Description of Services/Commodity Provided by Offeror:
Show Cause Order Issued on Contract (Yes/No)?
Stop Work Order Issued on Contract (Yes/No)?
Termination for Convenience, Cause, or Default Issued on Contract (Yes/No)?
Rating Guidelines:
| Rating |
| Quality of Service |
| Cost Control |
| Timeliness of Performance |
| Business Relations |
| 1: Unsatisfactory |
| Offeror is not in compliance and has jeopardized achievement of contract objectives |
| Offeror is unable to manage costs effectively |
| Offeror delays have jeopardized performance |
| Responses to inquiries and issues are not effective |
| 2: Satisfactory |
| Minor inefficiencies and errors have been identified |
| Offeror is usually effective in managing costs |
| Offeror is usually effective in meeting milestones and delivery schedule |
| Responses to inquiries and issues is usually effective |
| 3: Excellent |
| Offeror is in compliance with contract requirements and delivers quality services |
| Offeror is effective in managing costs and submits proper invoices |
| Offeror is effective in meeting and exceeding milestones and delivery schedule |
| Responses to inquiries have been effective and/or exceeded expectations and established deadlines |
Offeror Evaluation:
| Rating (List Number Based on Rating Guidelines Above) |
| Category |
| Description |
| Quality of Service |
| In compliance with contract requirements, submits accurate reports/deliverables, has effective personnel, and has achieved/maintained technical excellence: |
Comment from Reference: _______________________
| Cost Control |
| Has achieved efficiencies in costs, managed costs effectively, and has submitted timely/accurate invoices with supporting documentation: |
| Timeliness of Performance |
| Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule: |
| Business Relations |
| Has maintained effective management of contract, has exhibited reasonable/cooperative behavior, is responsive to contract requirements, is responsive to inquiries/issues, and is proactive about resolving problems: |
| |_| YES |_| NO |
| Overall Satisfaction |
| Would you (reference) choose to work with this Offeror again? |
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