D.2 - Attachment 2 - Past and PresentPerformance Survey.pdf

Solicitation 36C25624Q0518

PAST AND PRESENT PERFORMANCE SURVEY

FOR OFFICIAL USE ONLY (When Filled In)

SOLICITATION 36C25624Q0518

A. GENERAL INFORMATION:

Contractor’s Name: _____________________________________

Project Title or Brief Description of Work: __

Contract Number Provided by Offeror: _____ _____________

Contract Dollar Amount: $ ________

Types of work performed: _______________________________

Contract Period or Dates of Performance Provided by Offeror:

Contractor performed as the (1) Prime Contractor (2) Sub-Contractor _Prime Contractor_________________________________________

B. RESPONDENT INFORMATION (Point of Contact, Agency and Address):

POC Name:

Address:

Agency:

Phone: Fax: ______________ Email Address:

C. EMAIL COMPLETED SURVEY FORM TO: arlene.blade@va.gov

D. PERFORMANCE INFORMATION: Choose the letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE

PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF U OR M.

U M N S VG E

Unsatisfactory Marginal Neutral Satisfactory Very

Good Exceptional

Performance did not meet most contractual requirements.

There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements . There were problems, some of a serious nature, for which corrective action was only marginally effective.

No record of past performance or the record is inconclusive.

Performance met contract requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performanc e met all contract requiremen ts and exceeded some to the governmen t’s benefit.

There were a few minor problems which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner

QUALITY OF SERVICE (Circle Response)

1 Contractor's ability to meet minimum quality standards specified for performance E VG S N M U N/A

2 Contractor's ability to effectively control the quality of services provided E VG S N M U N/A

3 Contractor's compliance with contractual terms and conditions E VG S N M U N/A

4 Overall rating of contractor's quality of service E VG S N M U N/A

TIMELINESS OF PERFORMANCE (Circle Response)

1 Contractor's ability to meet specific response times and scheduled timeframes for completion of specific tasks. E VG S N M U N/A

2 Contractor's responsiveness/timeliness for providing administrative reports/documentations required by contract. E VG S N M U N/A

3 Contractor's timeliness in responding to emergency services requirements. E VG S N M U N/A

4 Overall rating of contractor's responsiveness/timeliness. E VG S N M U N/A

BUSINESS RELATIONS (Circle Response)

1 Contractor's ability to identify problems and potential problems and promptly notify the Contracting Officer E VG S N M U N/A

2 Contractor's ability to correct problems and prevent or mitigate potential problems in a timely manner. E VG S N M U N/A

3 Contractor's willingness to improve and correct noncompliance issues or concerns. E VG S N M U N/A

4 Contractor's ability to use effective approaches and provide technical expertise and resources to solve contract problems. E VG S N M U N/A

5 Extent to which the contractor has demonstrated reasonable and cooperative behavior. E VG S N M U N/A

6 Contractor's working relationship with the Contracting Officer, quality assurance personnel, and customers. E VG S N M U N/A

7 Contractor's flexibility in satisfying the requirements of its customers. E VG S N M U N/A

8 Extent to which the contractor provided prompt and courteous service when responding to customer complaints. E VG S N M U N/A

9 Overall rating of business relations. E VG S N M U N/A

MANAGEMENT OF KEY PERSONNEL (Circle Response)

Contractor's ability to select and retain cooperative and effective key personnel, such as the contract manager and quality control personnel.

E VG S N M U N/A

2 Extent key personnel were knowledgeable about contractual requirements. E VG S N M U N/A

3 Contractor's ability to meet appropriate staffing levels with qualified personnel in order to provide required services. E VG S N M U N/A

4 Overall rating of contractor's management of key personnel. E VG S N M U N/A

COMPLIANCE WITH ENVIRONMENTAL, SAFETY, HEALTH, AND SECURITY REQUIREMENTS (Circle Response)

1 Has the contractor ever received any Notices of Violations for noncompliance with environmental laws or regulations? YES NO

2 Contractor's compliance with safety requirements. E VG S N M U N/A

3 Contractor's compliance with security requirements. E VG S N M U N/A

CONTRACTUAL CONSIDERATIONS (Circle Response)

1 Has an election ever been made not to exercise an option or continue relations due to contractor's poor performance? YES NO

2 Has a Contract Discrepancy Report ever been issued? YES NO

3 Has a Cure Notice or Show Cause Notice ever been issued? YES NO

4 Extent to which the contractor provided reliable, supportable cost estimates or proposals. E VG S N M U N/A

5 Overall rating of contractor's performance under this contract. E VG S N M U N/A

6 Would you hire this contractor again? YES NO

WHAT IS YOUR OVERALL ASSESSMENT OF

FACTOR 1, PAST PERFORMANCE? (Circle Response) E VG S N M U N/A