ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX EQ ENDOSCOPE DRYING AND STORAGE CABINETS - HORIZONTAL.pdf
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- Solicitation number
- 36C10G25R0015
About this file
This document is a Past Performance Questionnaire for a Department of Veterans Affairs (VA) solicitation (No. 36C10G25R0015) seeking Endoscope Drying and Storage Cabinets - Horizontal. The questionnaire is designed to gather performance feedback from references about potential vendors, with ratings across four key categories: Quality of Service, Cost Control, Timeliness of Performance, and Business Relations. References are asked to evaluate vendors on a 0-4 scale, with 0 being unsatisfactory and 4 being excellent, and provide additional comments about the vendor's performance.
The evaluation focuses on specific performance metrics such as compliance with contract requirements, cost management effectiveness, milestone achievement, responsiveness to technical direction, and overall cooperative behavior. The questionnaire includes a section for references to indicate whether they would choose to work with the offeror again, providing a final assessment of overall satisfaction. References are requested to email the completed questionnaire to the VA Strategic Acquisition Center's Contract Specialist, Michael Andrews, by the solicitation's close date, which will help the VA assess potential vendors for the endoscope drying and storage cabinet contract.
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ATTACHMENT G
PAST PERFORMANCE QUESTIONNAIRE
SOLICITATION NO: 36C10G25R0015
DESCRIPTION: NX EQ Endoscope Drying and Storage Cabinets - Horizontal Offerors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of Three References from Past Three Years)
*Past Performance Questionnaires shall be emailed by each reference to Contract Specialist listed below.
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
TO: Contract Specialist-Michael Andrews E-MAIL: michael.andrews6@va.gov
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.
Please E-mail Questionnaire to Contract Specialist listed above by close of 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 Provided by Offeror:
Show Cause Order Issued on Contract mailto:michael.andrews6@va.gov
(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
0: 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
1: Poor Major problems have been encountered
Offeror has had major difficulty managing costs effectively
Offeror has had major difficulty meeting milestones and delivery schedule
Responses to inquiries and issues are marginally effective
2: Fair Some problems have been encountered
Offeror is having some problems managing costs effectively
Offeror is having some problems meeting milestones and delivery schedule
Responses to inquiries and issues is somewhat effective
3: Good 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
4: 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
Category Description on Rating Guidelines Above)
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:
Comment from Reference:
Timeliness of Performance
Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule:
Comment from Reference:
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:
Comment from Reference:
YES NO Overall Satisfaction
Would you (reference) choose to work with this offeror again?
Comment from Reference:
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