ATTACHMENT FIVE (5) PAST PERFORMANCE QUESTIONNAIRE.pdf

EVALUATION: Please rate the company using the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Assessment Definition

Outstanding (O) The company's performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the company were highly effective.

Above Average (A) The company's performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the company were effective.

Satisfactory (S) The company's performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the offeror were satisfactory.

Unacceptable (U) Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the company has yet to identify corrective actions or the company's proposed actions appear only marginally effective or were not fully implemented.

ATTACHMENT FIVE (5) – PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

Request for Quote: 36C24821Q1774 Veterans Integrated Service Network 8 (VISN 8)

3D Imaging Service Message to the assessor: Your assistance is requested by Mechelle D. Reaser, the Contracting Officer to assist with establishing the performance history for the Company named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to: Mechelle.Reaser@va.gov. If not enough space is provided, please attach additional information to this questionnaire.

1. Name of Company /Agency:

Contract or Identifying Number:

Title/Description of Contract:

Based upon the definitions below, indicate your assessment of the company’s performance. Your assessment should consider the company’s performance in accordance with the contractual requirements. Please include the period of performance and contract value:

2. Brief description of scope of work:

Completed scheduled services in a timely manner per the Performance Work Statement (PWS).

O A S U

Compliance with contractual Terms and Conditions. O A S U Provided experienced personnel with the technical and administrative abilities needed to meet contract requirements.

O A S U

Demonstrated ability to hire, maintain, and replace, if necessary, personnel during the contract period.

O A S U

Provided effective quality control and/or inspection procedures to meet contract requirements.

O A S U

Corrected deficiencies in a timely manner and pursuant to the company's quality control procedures.

O A S U

Exhibited knowledge of and compliance with Government (or other) regulations and industry standards.

O A S U

How effective was the company in responding to urgent requests in a timely manner per the Performance Work Statement (PWS)?

O A S U

To what extent was the company able to solve contract performance problems without extensive guidance from procurement or technical personnel?

O A S U

Provides timely and accurate documents, records, and invoices as required by the contract.

O A S U

Would you award similar contracts to this company? Please provide explanation for response.

O A S U

Rate the company's OVERALL quality of performance under this contract O A S U

EXPLANATION OF OVERALL RATING GIVEN:

ADDITIONAL COMMENTS (as required)

Name & Signature of Assessor’s:

Company/Agency: Date:

Position Title/Grade: Phone:

Email: Fax: