D.11 PAST PERFORMANCE CONTACTS.pdf

PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

Past Performance Survey

The Offeror is to provide this form to a minimum of three (3) current/past performance references for Health Care for Homeless Veteran (HCHV) services conducted within the past three years, to include the names and phone numbers of responsible individuals who would have firsthand knowledge of the performance.

Questionnaires are to be returned via email by the Offeror’s Reference to Maria Riza R. Owen, Contract Specialist at maria.owen2@va.gov. The email subject line should include 36C25523Q0209, Past Performance Questionnaire.

Questionnaires are to be returned by the Solicitation’s due date/time identified on the SF 1449, block 8, unless it has been extended via Solicitation Amendment.

Questionnaires submitted by the Offeror will not be considered.

Business Name: _____________________________________________________________

Business Address: ___________________________________________________________

Contact Person: ___________________________ Title: ____________________________

Email Address: ______________________________________________________________

Telephone Number: _________________________ Contract Value: $__________________

Contract Number/Reference: ___________________________________________________

Contract Period of Performance Dates: ___________________________________________ mailto:maria.owen2@va.gov

BRIEF DESCRIPTION OF SERVICES PROVIDED:

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the offeror’s performance or situation. If you are unable to rate an item because it was not a requirement, never an issue, or you have no knowledge of the item in question, then you should mark “NA”.

Exceptional. (6) Performance meets contractual requirements and exceeds many requirements to the government’s benefit. (Risk Level: Very Low)

Very Good. (5) Performance meets contractual requirements and exceeds some to the government’s benefit.

(Risk Level: Low)

Satisfactory. (4) Performance meets contractual requirements. (Risk Level: Moderate)

Marginal. (3) Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet implemented satisfactory corrective actions. (Risk Level:

High)

Unsatisfactory. (2) Performance does not meet contractual requirements and recovery is not likely in a timely manner. Contractor’s corrective actions to date are ineffective (Risk Level: Very High)

Unknown. (1) The offeror has little/no relevant past performance upon which to base a meaningful performance risk prediction. (Risk Level: Unknown)

a. QUALITY OF PRODUCT OR SERVICE:

(1) The Contractor provided services that conformed to contract requirements, specifications, and standards of safety.

1 2 3 4 5 6 NA

(2) The Contractor submitted accurate reports/surveys. 1 2 3 4 5 6 NA

(3) The Contractor utilized personnel that were appropriate to the effort performed.

1 2 3 4 5 6 NA

(4) The Contractor established and maintained adequate management of subcontractors to ensure quality service.

1 2 3 4 5 6 NA

b. PRICE CONTROL:

(1) The Contractor performed the effort within the cost/price. 1 2 3 4 5 6 NA

(2) The Contractor submitted accurate invoices on a timely basis. 1 2 3 4 5 6 NA

c. TIMELINESS/SCHEDULE:

(1) The tasks required under this effort were performed in a timely manner and in accordance with the period of performance of the contract.

1 2 3 4 5 6 NA

(2) The Contractor was responsive to technical and/or contractual direction. 1 2 3 4 5 6 NA

d. BUSINESS RELATIONSHIPS:

(1) The Contractor demonstrated effective management over the effort performed. 1 2 3 4 5 6 NA

(2) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) was apprised of technical, cost, and safety issues.

NA

(3) The Contractor presented information, reports, surveys and correspondence in a clear, concise, and businesslike manner.

1 2 3 4 5 6 NA

(4) The Contractor promptly notified the COR and/or Contracting Officer in a timely manner regarding urgent issues.

1 2 3 4 5 6 NA

(5) The Contractor cooperated with the Government in providing flexible, proactive, and effective recommended solutions to critical contract issues.

1 2 3 4 5 6 NA

e. KEY PERSONNEL:

(1) The Contractor provided qualified personnel to fulfill the requirements of the contract.

1 2 3 4 5 6 NA

A. OTHER:

(1) Would you award this contractor/offeror another contract? ( ) Yes, ( ) No If you answered “No” provide an explanation.

(2) Was the contract terminated for default? ( ) Yes, ( ) No If you answered “Yes”, provide an explanation.

(3) Has the contractor/offeror ever been given a cure notice, show cause notice, suspension of progress payments, etc.? ( ) Yes, ( ) No If you answered “Yes”, provide an explanation.

(4) Based upon the information you provided and using the definitions provided in the evaluation criteria above, the overall performance rating you would give this contractor is:

Exceptional , Very Good , Satisfactory , Marginal , Unsatisfactory , Unknown , COMMENTS: (ALL Unsatisfactory, Marginal, Very Good, or Exceptional Ratings require comments to support the same.)