ATTACHMENT F_PAST PERFORMANCE QUESTIONNAIRE_PAPR_04012025.docx
DOCX document 32 KB Posted
- Attached to
- 6515--NX EQ Powered Air Purifying Respirators
- Solicitation number
- 36C10G25Q0059
About this file
This document is a Past Performance Questionnaire for a Department of Veterans Affairs (VA) Strategic Acquisition Center solicitation for Powered Air-purifying Respirators (PAPR). The solicitation (No. 36C10G25Q0059) is a 100% Service-Disabled Veteran Owned Small Business set-aside for the Veterans Health Administration's national medical center equipment program. The contract will be a single requirements contract with a 12-month base period and four 12-month option periods, using firm-fixed pricing and FOB destination delivery.
The Past Performance Questionnaire is designed for references to evaluate potential contractors across four key performance categories: Quality of Service, Cost Control, Timeliness of Performance, and Business Relations. References are asked to rate the contractor on a scale of 1-3 (Unsatisfactory to Excellent) and provide comments. The VA will use these evaluations to assess quoter performance, with a maximum of three references from the past three years allowed. Completed questionnaires should be emailed to Anthony.Zibolski@va.gov and Sara.Vickroy@va.gov, with the solicitation number in the subject line.
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SOLICITATION NO.: 36C10G25Q0059
DESCRIPTION: Powered Air-purifying Respirators
Attachment F Past Performance Questionnaire
SOLICITATION NO.: 36C10G25Q0059
DESCRIPTION: Powered Air-purifying Respirators
Quoters: Please Send to Each Reference Cited in Submitted Quote (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: Anthony.Zibolski@va.gov and Sara.Vickroy@va.gov, ensuring that the email subject line includes “36C10G25Q0059”
VA SAC is currently in the process of awarding a contract for the solicitation described above. The quoter identified below has provided your organization’s name as a reference under the contract described below:
| Quoter Name: |
| (Insert Quoter’s Name Here) |
| Contract Number: |
| (Insert Applicable Contract Number Here) |
Please rate the quoter 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 “Quoter Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this quoter’s past performance. Thank you for your organization’s assistance in fairly evaluating quoter quotes 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 Quoter:
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 |
| Quoter is not in compliance and has jeopardized achievement of contract objectives |
| Quoter is unable to manage costs effectively |
| Quoter delays have jeopardized performance |
| Responses to inquiries and issues are not effective |
| 2: Satisfactory |
| Minor inefficiencies and errors have been identified |
| Quoter is usually effective in managing costs |
| Quoter is usually effective in meeting milestones and delivery schedule |
| Responses to inquiries and issues is usually effective |
| 3: Excellent |
| Quoter is in compliance with contract requirements and delivers quality services |
| Quoter is effective in managing costs and submits proper invoices |
| Quoter is effective in meeting and exceeding milestones and delivery schedule |
| Responses to inquiries have been effective and/or exceeded expectations and established deadlines |
Quoter 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 quoter again? |
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