D.2 ATTACHMENT - Past Performance Questionnaire.docx
DOCX document 21 KB Posted
- Solicitation number
- 36C26224R0136
About this file
This document is a Past Performance Questionnaire for Solicitation No. 36C26224R0136 for Health Care for Homeless Veterans (HCHV) services to be provided to the Department of Veterans Affairs Medical Center (VAMC), servicing the Southern Arizona VA Health Care System (SAVAHCS) in Tucson, Arizona. The Network Contract Office (NCO) 22 intends to award a non-personnel services Contract to provide care, treatment, and rehabilitative services, including case management services and therapeutic transitional housing assistance for the HCHV programs.
The Questionnaire requests the respondent to provide information on the contractor's performance in areas such as management effectiveness, quality of service, timeliness, and customer satisfaction. It also asks if the contractor received any Contract Discrepancy Reports, Letters of Concern, or Cure Notices, and if the respondent would award another contract to this contractor. The completed Questionnaire must be returned to the Contracting Officer by November 5, 2024, by 7:00AM PDT.
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Other files
| File | Type | Posted |
|---|---|---|
| S05 Responses to Vendor Questions_RFP 36C26224R0136 HCHV SAVAHCS.pdf | ||
| S02 RFP 36C26224R0136 0001 HCHV SAVAHCS 12.03.2024.pdf | ||
| 36C26224R0136 0001_1.docx | DOCX document | |
| 36C26224R0136_1.docx | DOCX document | |
| S02 RFP 36C26224R0136 HCHV SAVAHCS.pdf | ||
| D.1 ATTACHMENT - Inspection Form 02.pdf | ||
| D.3 ATTACHMENT - BAA.docx | DOCX document |
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Solicitation 36C26224R0136, Health Care for Homeless Veterans (SAVAHCS) D.2 Attachment – Past Performance Questionnaire
The below-named contractor is being considered for award of a Contract for Solicitation No. 36C26224R0136 for Health Care for Homeless Veterans (thereafter referred to as HCHV) services to be furnished to the Department of Veterans Affairs Medical Center (VAMC), servicing the Southern Arizona VA Health Care System (SAVAHCS), Tucson, Arizona. Network Contract Office (NCO) 22 intends to award a non-personnel services Contract to provide care, treatment, and rehabilitative services, including case management services; and therapeutic transitional housing assistance for the HCHV programs.
A primary consideration in our selection process is the contractor’s history of performance of similar efforts. PLEASE COMPLETE THIS FORM and RETURN VIA EMAIL TO: Soledad.Delatorre@va.gov, Contract Specialist/Contracting Officer, (562)766-2313 FORMS MUST BE RECEIVED BY THE CONTRACTING OFFICER NOT LATER THAN November 5, 2024, by 7:00AM PDT or as otherwise specified on the Solicitation/Contract/Order for Commercial Items, Standard Form 1449, Block 8, Offer Due Date/Local Time.
A. GENERAL INFORMATION
Contractor’s Name: ___________________________________________________________ Address: _____________________________________________________________________ Telephone Number: _____________________ Point of Contact: ________________________
B. RESPONDENT INFORMATION
Name: _______________________________ Title: ________________________________ Organization & Address: ________________________________________________________ Telephone: __________________ Fax: ________________ Email: _____________________
C. CONTRACT INFORMATION
Contract Number/Title: __________________________________________________________ Period of Performance: ________________ Current Dollar Amount of Contract: ___________ Services Performed: ____________________________________________________________
D. PERFORMANCE INFORMATION
Choose the category on the below scale that most accurately describes the contractor’s performance or situation.
| E |
| M |
| F |
| Exceeds the standard. |
| Meets the standard. |
| Fails-please note the issue/problem/resolution |
Please use the above ratings to describe the contractor’s performance in the following areas:
1. MANAGEMENT EFFECTIVENESS
| a. Contractor provided experienced managers and supervisors with technical and administrative abilities to meet contract requirements |
| E M F |
| b. Contractor handled staff integrity issues appropriately |
| E M F |
| c. Contractor’s overall management effectiveness |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. QUALITY OF SERVICE AND WORKMANSHIP
| a. Contractor maintained safe, clean, and acceptable residential treatment facility. |
| E M F |
| b. Contractor provide appropriate treatment plans for individual treatment facility. |
| E M F |
| c. Contractor provided acceptable/immediate response when issues arose. |
| E M F |
| d. Contractor’s overall quality of service. |
| E M F |
COMMENTS/REMARKS:___________________________________________________________________________________________________________________________________________________________________________________________________________________
3. TIMELINESS/ADHERENCE TO SCHEDULES
| a. Contractor responded to technical support issues in a timely manner |
| E M F |
| b. Overall contractor timeliness |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. CUSTOMER SATISFACTION
| a. Contractor maintained a professional working relationship |
| E M F |
| b. Contractor was reasonable and cooperative in resolving any customer complaints |
| E M F |
| c. Contractor was flexible in responding to customer requirements |
| E M F |
| d. Overall customer satisfaction |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
E. If a government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? __________ if yes, please describe:
F. If given the opportunity, would you award another contract to this contractor? Please explain response below.
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