D.3 PAST PERFORMANCE SURVEY.docx
DOCX document 17 KB Posted
- Attached to
- H266--Testing and Certification of Laboratory Exhaust Hoods, Safety Cabinets, and Clean Benches
- Solicitation number
- 36C26126Q0091
About this file
This is a Past Performance Survey form for solicitation 36C26126Q0091, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21 for testing and certification of laboratory exhaust hoods, safety cabinets, and clean benches. The survey serves as a reference evaluation tool that offerors must submit to gather feedback from past clients regarding their performance on relevant contracts.
Offerors are required to have a separate survey completed and signed by each reference and must submit completed surveys directly to durell.salaz@va.gov. Evaluators providing references must document the company being evaluated, their name and signature, company name, address, and phone number, along with a summary of services provided including performance dates, dollar amounts, and contract numbers. The evaluation section requests ratings on overall quality of work using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) and requires documentation of any performance issues, concerns, and how they were resolved. The form is designed to maintain the confidentiality of reference providers, with their names not being released or made publicly available.
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Text version
Past Performance Survey 36C26126Q0091
OFFEROR INSTRUCTIONS: A separate survey must be completed and signed for each reference. The completed surveys must be submitted directly to durell.salaz@va.gov.
EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the company listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. The name of the individuals providing reference information is confidential and will not be released or made publicly available.
Please Note: When completing this Survey be sure to summarize what service(s) you provided on the contract(s) to include the performance dates, dollar amount(s) and contract number(s).
Name of Company being evaluated:
Evaluator’s Name and signature: Must be signed
Evaluator’s Company Name, Address and Phone number:
Indicate what services did this company provided for you? Provide the total contract amount, dates of performance, and contract number.
Evaluation Questions
Please rate the overall quality of work using a scale of (Excellent, Good, Fair, Marginal, Unacceptable). Comments in support of the rating are welcome.
Were there any performance issues/concerns? If so, how were they handled?
How did the Contractor perform on the contract?
Were there any issues and how did they handle them?
File details come from the government source that posted it. Updated .