D.4 Past Performance Questionnaire.pdf
PDF 121 KB Posted
- Attached to
- Q403--On-Site Sleep Study Services and Scoring
- Solicitation number
- 36C25526Q0038
About this file
This is a Past Performance Questionnaire used by the Department of Veterans Affairs for contract number 36C25526Q0038. The form is designed to be completed by references or past customers to evaluate a contractor's performance on previous contracts and must be returned by July 10, 2026, via email to Kayla.Haas@va.gov.
The questionnaire requires evaluators to rate contractor performance across twelve dimensions using a five-point scale: Outstanding (O), Above Average (A), Satisfactory (S), Marginal (M), or Unacceptable (U). Evaluated areas include compliance with contract requirements, accuracy of required reports, appropriateness of personnel assigned, technical expertise, schedule performance, flexibility in responding to changing needs, reliability, responsiveness to technical directions, and problem notification practices. The form also requests specific information regarding any cure notices, show cause letters, payment suspensions, or terminations issued; whether the evaluator would award a future contract to the contractor; and overall customer satisfaction with the end product. The questionnaire includes space for detailed comments, the evaluator's name, signature, date, title, company, and telephone number. This template does not address specific products or services but rather serves as an evaluation instrument for assessing contractor performance history.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25526Q0038 0003.docx | DOCX document | |
| P07 Wage Determination 2026-0084 Rev. 1.pdf | ||
| 36C25526Q0038 0002.docx | DOCX document | |
| 36C25526Q0038 0001.docx | DOCX document | |
| 36C25526Q0038_1.docx | DOCX document | |
| D.3 Wage Det 2015-5341_Rev 32 dated 5-13-26.pdf | ||
| D.2 Contractor Certification Immigration and Nationality Act of 1952.pdf | ||
| D.1 Quality Assurance Surveillance Plan_QASP.pdf |
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Text version
Attachment D.4 Past Performance Questionnaire_36C25526Q0038
PAST PERFORMANCE QUESTIONNAIRE
Your assistance is requested by the Department of Veterans Affairs to assist with establishing the performance history for the Company (Offeror) named below. In efforts to expedite receipt of the requested information, please email the completed past performance questionnaire(s) to: Kayla.Haas@va.gov. Please return this questionnaire on or before 7/10/2026.
Offeror’s Name:
Contract Number:
Contract Type and Dollar Value:
Brief Description of Work:
“O” =Outstanding = Performance greatly exceeded the contract requirements
“A” =Above Average = Performance exceeded the contract requirements
“S” = Satisfactory = Performance met the contract requirements
“M” = Marginal = Performance met the minimum contract requirements, but some material aspects of the contractor’s performance were less than satisfactory
“U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements
Please rate and provide information and detailed comments for the following:
Circle one
1. To what extent did the contractor comply with contract requirements? O A S M U
2. If reports were required, were they accurate in meeting contract requirements? O A S M U
3. To what extent did the contractor use appropriate personnel for contract requirements?
O A S M U
4. To what extent did the contractor display technical expertise? O A S M U
5. To what extent was contractor able to meet the performance schedule? O A S M U mailto:Kayla.Haas@va.gov
Attachment D.4 Past Performance Questionnaire_36C25526Q0038
6. To what extent was contractor flexible in responding to changing needs? O A S M U
7. To what extent was the contractor reliable? O A S M U
8. To what extent was the contractor responsive to technical directions? O A S M U
9. To what extent did contractor notify you of problems or potential problems? O A S M U
10. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
O A S M U
11. Would you award another contract to the party being evaluated? If no, please explain:
O A S M U
12. Was the customer satisfied with the end product? If no, please explain: O A S M U
Additional Comments:
Name of Evaluator:
Signature of Evaluator: Date:______________
Title:
Company:
Telephone No.:
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