Attachment S2 - PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C79122R0006
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Other files
| File | Type | Posted |
|---|---|---|
| 36C79122R0006 0002.docx | DOCX document | |
| 36C79122R0006 0001.docx | DOCX document | |
| Attachment IV - VISNs to Zip Codes.xlsx | XLSX spreadsheet | |
| Attachment V - VHA Dental Network Map-Rating Regions.pdf | ||
| Attachment VIII - Definitions and Acronyms.xlsx | XLSX spreadsheet | |
| Attachment VII - VET Population 2019 by County and State.docx | DOCX document | |
| Attachment IX - Dental Plan Charts-Basic-Standard-High.xlsx | XLSX spreadsheet | |
| Attachment I - Quality Assurance Surveillance Plan v2.docx | DOCX document | |
| Attachment VI - CHAMPVA Enrolled by ZIP FY17-FY20.xlsx | XLSX spreadsheet | |
| S01-VADIP-36C79122R0006-Final 06-08-22.docx | DOCX document | |
| Attachment III - Enrolled Vets Demographics Sep 30 2020.xlsx | XLSX spreadsheet | |
| Attachment II - Performance Requirements Summary Table.xlsx | XLSX spreadsheet |
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Text version
SOURCE SELECTION PLAN
The Department of Veterans Affairs National Acquisition Center, Commodities and Services Acquisition Service/Denver Logistics Center
APPENDIX D – PAST PERFORMANCE QUESTIONNAIRE
This information will be provided to the U.S. Department of Veterans Affairs, for use in selecting a contractor to perform service/supply work for Solicitation # 36C79122R0006- VA Dental Insurance Plans (VADIP).
This information must be submitted no later than the date of receipt of proposals as stated in Block 8 of the SF-1449. It is the offeror’s responsibility to ensure each questionnaire is distributed timely and ensures that the company providing past performance information submits the completed form on time. IT IS THE RESPONSIBILITY OF THE COMPANY FILLING OUT FORM TO SUBMIT.
Completed forms shall be submitted by email to: Bradley Geghan, bradley.geghan@va.gov Subject Line should read as: Solicitation #, Past Performance Questionnaire Describe the nature of your contract with the referenced Vendor (If more space is needed, please use the (“Additional Comments” block on the second page)
| Solicitation Number |
| 36C79122R0006 |
Offeror under Evaluation Name
Company/Organization Providing Reference
Company Representative Completing Questionnaire
Company Representative Email
Company Representative Phone Number
Contract Description the Offeror was Awarded
Contract Number or Project ID
Period of Performance
Contract Award Amount/Premiums
What was the role of Offeror? Prime or Subcontractor?
Complete the following questions, by marking the adjectival ratings and providing comments in which there was significant discrepancies or excellent performance.
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.
ADJECTIVAL RATINGS DEFINITIONS
| “E” |
| Excellent: Performance meets contractual requirements and exceeds the Government’s expectations. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
(HIGH CONFIDENCE)
| “VS” |
| Very Good: Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. (SIGNIFICANT CONFIDENCE) |
| “S” |
| Satisfactory: Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective action taken by the contractor appear or were satisfactory. (CONFIDENCE) |
| “M” |
| Marginal: Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. (LITTLE CONFIDENCE) |
| “U” |
| Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective. (NO CONFIDENCE) |
| “N” |
| Neutral: No relevant past performance record is identifiable upon which to base a meaningful performance risk prediction. A search was unable to identify any relevant past performance information for the contractor or their key personnel. (This is neither a negative nor positive assessment.). |
| PAST PERFORMANCE |
| ADJECTIVAL RATINGS |
| 1. How well were the contract requirements met in compliance with contractual terms and conditions? |
| E |
| VS |
| S |
| M |
| U |
| N |
Compliance of technical data/report preparation terms?
Comments:
| 2. To what extent did the contractor adhere to the |
| E |
| VS |
| S |
| M |
| U |
| N |
Performance schedule? Quality Control?
Comments:
| 3. How responsive was the contractor in resolving quality, schedule, or other contract |
| E |
| VS |
| S |
| M |
| U |
| N |
issues?
Comments:
| 4. How effective was the contractor in addressing unforeseen or unusual customer |
| E |
| VS |
| S |
| M |
| U |
| N |
needs and issues?
Comments:
| 5. How well was the contractor in ability to meet quality standards for technical |
| E |
| VS |
| S |
| M |
| U |
| N |
performance?
Comments:
| 6b. If you represent a government agency, and the contract included a small business subcontracting plan, how was performance against subcontract goals? |
| E |
| VS |
| S |
| M |
| U |
| N |
| 6c. If you represent a government agency, and the contract included a small business subcontracting plan, how was compliance with subcontracting plan in general? |
| E |
| VS |
| S |
| M |
| U |
| N |
| 6d. If you represent a government agency, and the contract included a small business subcontracting plan, was there timely eSRS reporting? |
| E |
| VS |
| S |
| M |
| U |
| N |
Comments:
| 7. How satisfied were you with the contractor’s overall performance? |
| E |
| VS |
| S |
| M |
| U |
| N |
Comments:
Additional Comments:
Thank you for your response.
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