Attachment J - Past Performance Questionnaire.docx

36C10F26ROO45 PPQ

ATTACHMENT J

PAST PERFORMANCE QUESTIONNAIRE

The evaluator shall complete the questionnaire and submit via email to Kevin.Armillotti@va.gov, Danny.Killian@va.gov, and Fritz.Fabien@va.gov with the following Subject Line:

36C10F26R0045 – [Input Contractor Name] – Completed Past Performance Questionnaire

The completed questionnaire must be received by the Government no later than [Input Month X, 20XX].

Evaluator Information

Company/Organization:

Name:

Duty Position/Title:

Phone Number:

Email Address:

I. REFERENCED CONTRACTOR INFORMATION: Please complete the following questionnaire on the below-listed contractor who has provided services in the past or is currently providing services for your company/organization. If any information is incorrect or incomplete, please provide the complete accurate information.

a. Contractor Information:

1. Company Name:

2. Point of Contact:

3. Contractor Address:

4. Contractor Phone:

II. PERFORMANCE INFORMATION: When responding to the following statements, choose the number on the scale of 1 to 5, based on the corresponding adjective definitions described below, which most accurately describes the Contractor's performance under the referenced contract or project. If the statement is not applicable to the circumstance of this contract effort, circle N/A. The numbers correspond with the following adjective ratings:

ADJECTIVE RATING DEFINITIONS:

Outstanding: Performance consistently exceeded contract or project requirements and produced significant benefits to the customer. The Contractor demonstrated exceptional quality, timeliness, responsiveness, technical capability, communication, and problem-solving. Any minor issues were resolved promptly and effectively.

Very Good: Performance exceeded contract or project requirements in important respects and provided clear benefits to the customer. The Contractor demonstrated strong quality, timeliness, responsiveness, technical capability, communication, and problem-solving. Any issues were minor and were resolved effectively.

Acceptable: Performance met contract or project requirements. The Contractor delivered generally satisfactory quality, timeliness, responsiveness, technical capability, communication, and problem-solving. Any issues were minor or were corrected without material impact to the contract or project.

Marginal: Performance did not consistently meet contract or project requirements. The Contractor experienced significant issues affecting quality, timeliness, responsiveness, technical capability, communication, or problem-solving. Corrective actions were incomplete, delayed, or only partly effective.

Unsatisfactory: Performance failed to meet contract or project requirements in significant respects. The Contractor experienced serious or recurring issues that materially affected quality, timeliness, responsiveness, technical capability, communication, or problem-solving. Corrective actions were ineffective, not timely, or did not resolve the identified issues.

Not Applicable: The statement does not apply to the referenced contract or project, or the evaluator does not have sufficient firsthand knowledge to provide a rating. Provide a brief explanation in the associated comments field.

For any rating of Outstanding, Marginal, or Unsatisfactory, please provide a brief factual explanation in the Comments/Remarks field.

THE CONTRACTOR:

1. Developed and maintained realistic project schedules, met required milestones and delivery dates, and performed in accordance with applicable contract or project requirements.

COMMENTS/REMARKS:

2. Provided qualified personnel with the technical, administrative, and project-management capabilities necessary to perform the required services. Maintained sufficient staffing and continuity of operations to avoid material disruption to performance.

3. Communicated clearly, promptly, professionally, and effectively with the customer and other project stakeholders.

4. Maintained effective quality-control processes that resulted in accurate, complete, timely, and compliant services and deliverables.

5. Identified actual or potential performance issues in a timely manner; communicated those issues to the customer; and provided practical, well-supported recommendations or alternatives to assist in resolving them.

6. Responded promptly and effectively to changing project conditions, customer requirements, schedule risks, or other issues within the Contractor’s scope of responsibility.

7. Responded promptly and appropriately to customer direction, questions, comments, and requests for information, within the Contractor’s authorized scope of responsibility.

8. Effectiveness in providing analysis, documentation, coordination, and other support for customer-led negotiations, evaluations, or related acquisition or real-estate decisions, when applicable.

9. During the referenced contract or project, did the Contractor receive any written notice of deficient performance, cure notice, show-cause notice, corrective-action request, payment withholding, termination notice, or comparable customer action related to its performance?

If Yes, identify the issue, the action taken, the Contractor’s corrective action, and the final outcome:

10. Corrected deficiencies, errors, omissions, or other nonconforming services or deliverables promptly and effectively when identified.

11. Resolved performance, schedule, scope, or customer-service issues in a timely manner.

12. Demonstrated professional, cooperative, ethical, and customer-focused conduct; maintained constructive working relationships; and acted with appropriate regard for the customer’s interests and project objectives.

Please provide any additional comments or remarks you feel may be useful in evaluating the respective contractor below:

Thank you for your time and effort in completing this Past Performance Questionnaire.