D.2 PAST PERFORMANCE QUESTIONAIRE.docx

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE

(To be completed by References)

Request for Proposal Number: 36C24721Q0427, closing date: See RFQ 36C24721Q0427 for closing Date/time.

Submit completed Cover Sheet and Survey via email to:

Department of Veterans Affairs, RHJ VA Medical Center 109 Bee Street Charleston, SC 29401

David W. Parente, Contracting Officer Network Contracting Office (NCO) 7 Email: david.parente@va.gov

*Do not return this form to the contractor being evaluated. It is desired that this form be submitted to the person identified above, no later than RFP closing date of TBD.

1. Handwritten responses are acceptable. If a response is handwritten, please print legibly.

2. If more space is needed for narrative comments, use the back of the survey or attach additional pages.

3. Your time and effort in providing this vitally important information is greatly appreciated.

GENERAL INFORMATION

Please provide the following information:

Name of Company for which you are filling out this survey:

General Description of Contract Services: _______________________________________ Contract Dollar Value: ________________________________________________________ Type of Contract (firm fixed price, cost plus fixed fee, etc.): _______ ____________

REMARKS: (Add on separate sheet.)

CONTRACTOR PERFORMANCE EVALUATION SURVEY RATING SHEET

RATING SCALE

Please use the following rating to answer the questions. If you are unable to rate any item because it was not a requirements, never an issue, or you have no knowledge of the item in question, then you should mark “N/A”.

EVALUATION CRITERIA

Excellent The Company’s performance was consistently superior. Performance was entirely favorable and you wouldn’t hesitate to do business with them again.

Good The Company’s performance was better than average, and you would willingly do business with them again. The contractual performance was mostly favorable and corrective actions taken by the contractor were effective.

Neutral No record of relevant past performance or any information on past performance is available.

Satisfactory The company’s performance was satisfactory and you would consider doing business with them attain. There were minor performance problems that were satisfactorily corrected.

Poor the Company’s performance was entirely unsatisfactory and you would not do business with them again under any circumstances. There were serious performance issues with the contractor for which the contractor’s corrective actions were ineffective.

NOTE: For statements indicating “Poor” or “Excellent”, please provide and explanation in the Comments section of the survey.

CONTRACTOR PERFORMANCE EVALUATION SURVEY RATING SHEET

FOR RFQ: 36C24721Q0427

A. QUALITY OF PRODUCT OR SERVICE

(1) The Contractor provided a product or service that conformed to contract requirements, specifications and standards of good workmanship

(2) The Contractor submitted accurate reports.

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

B. COST CONTROL

(1) The Contractor performed the effort within the estimated cost/price.

(2) The Contractor submitted accurate invoices on a timely basis.

(3) The Contractor demonstrated cost efficiencies in performing the required effort.

(4) The actual costs/rates realized closely reflected the negotiated costs/rates.

C. 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.

(2) The Contractor was responsive to technical and/or contractual direction.

D. BUSINESS RELATIONSHIPS

(1) The Contractor demonstrated effective management over the effort performed.

(2) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) and/or Technical Point of Contact (TPOC) were apprised of technical, cost and schedule issues.

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

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

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

(6) The Contractor made timely award to, and demonstrated effective management of, its subcontractors.

(7) The Contractor demonstrated an effective small/small disadvantaged business subcontracting program.

E. CUSTOMER SATISFACTION

(1) The products/services provided adequately met the needs of the program.

(2) The Contractor was able to perform with minimal or no direction from the COR or TPOC.

(3) I am satisfied with the performance of the Contractor under this effort.

F. Key Personnel

(1) The labor turnover in key personnel labor categories was minimal and did not adversely affect Contractor performance

(2) The Contractor proposed qualified personnel to fulfill the requirements of the contract.

G. OTHER:

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

(2) Was the contract terminated for default? ( ) Yes ( ) No

COMMENTS: (Required for ALL Poor and Excellent Ratings)