ATTACHMENT - PAST PERFORMANCE QUESTIONAIRE.docx
DOCX document 21 KB Posted
- Attached to
- 6515--Orthotic Softgoods and Prosthetic Supplies
- Solicitation number
- 36S79725R0002
About this file
This document is a Past Performance Questionnaire for Solicitation 36S79725R0002, a Department of Veterans Affairs procurement for Orthotic Softgoods and Prosthetic Supplies. The questionnaire is designed to collect detailed performance feedback about a contractor, with six evaluation categories including contract requirements fulfillment, schedule adherence, responsiveness to issues, effectiveness in addressing customer needs, overall performance satisfaction, and small business subcontracting plan compliance.
The questionnaire utilizes a six-point adjectival rating scale ranging from "Excellent" to "Neutral", allowing the reference provider to rate the contractor's performance across multiple dimensions. The completed form should be mailed directly to VA National Acquisition Center Commodities and Services Acquisition Service, specifically to Miguel Vasquez and Stephen Wilson, located at 555 Corporate Circle, Golden, CO 80401. The document emphasizes that in accordance with Federal Acquisition Regulations, contractors may be advised of adverse remarks but will not be provided the name of the reference or copies of the questionnaire.
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Text version
Solicitation 36S79725R0002
PAST PERFORMANCE QUESTIONNAIRE
PAST PERFORMANCE QUESTIONNAIRE
Name of Contractor being Evaluated:
Company Providing Reference: _______________________________________________________________________ Contract Number: _________________________________________________________________________ Nature of Contract: ________________________________________________________________________ Contract Period of Performance: ______________________________________________________________ Name and Title of Person Completing Questionnaire: ______________________________________________ Company/Organization: ______________________________________________________________________ Phone Number/E-mail Address: ________________________________________________________________ PLEASE MAIL THIS COMPLETED QUESTIONNAIRE DIRECTLY TO: VA, VA National Acquisition Center Commodities and Services Acquisition Service Attn: Miguel Vasquez and Stephen Wilson, Solicitation 36C79119R0004, 555 Corporate Circle, Golden, CO 80401
Describe the nature of your contract with the above referenced Vendor and types/models of products purchased from the Vendor. (If more space is needed, please use the “Additional Comments” block on the second page)
ADJECTIVAL RATING DEFINITIONS
| “E” |
| Excellent: Performance greatly exceeded contract requirements resulting in overall benefits to the customer with no significant weaknesses or complaints. |
| “VG” |
| Very Good: Performance consistently met and often exceeded many of the contract requirements with very few weaknesses or complaints. |
| “G” |
| Good: Performance consistently met contract requirements with noted weaknesses or complaints adequately corrected. |
| “F” |
| Fair: Performance often failed to meet minimum contract requirements with numerous noted weaknesses or complaints usually corrected. |
| “P” |
| Poor: Performance consistently failed to meet contract requirements with numerous significant weaknesses or complaints left uncorrected. |
| “N” |
| Neutral: No relevant past performance available for evaluation. Receives no merit of demerit for this factor. |
| PAST PERFORMANCE |
| ADJECTIVAL RATINGS |
| 1. How well were the contract requirements met? |
| E |
| VG |
| G |
| F |
| P |
| N |
Comments:
| 2. To what extent did the contractor adhere to the |
| E |
| VG |
| G |
| F |
| P |
| N |
schedule?
Comments:
| 3. How responsive was the contractor in resolving |
| E |
| VG |
| G |
| F |
| P |
| N |
quality, schedule, or other contract issues?
Comments:
| 4. How effective was the contractor in addressing |
| E |
| VG |
| G |
| F |
| P |
| N |
unforeseen or unusual customer needs and issues?
Comments:
| 5. How satisfied were you with the contractor’s overall |
| E |
| VG |
| G |
| F |
| P |
| N |
performance?
Comments:
6. If you represent a government agency, and the contract included a small business subcontracting plan, how well did the contractor adhere to the plan requirements?
| E |
| VG |
| G |
| F |
| P |
| N |
Comments:
Additional Comments:
PLEASE NOTE: In accordance with Federal Acquisition Regulations, contractors may be advised of adverse remarks and given an opportunity to respond. However, the contracting officer will not provide your name or copies of this questionnaire to the contractor or any other party not directly involved in the evaluation of the contractor’s proposal.
THANK YOU FOR YOUR RESPONSE
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