D.5 ATTACHMENT 5 – Past Performance 36C25525Q0561.pdf
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- Solicitation number
- 36C25525Q0561
About this file
This document is a Past Performance Survey template for solicitation number 36C25525Q0561 issued by the Department of Veterans Affairs. The survey is designed to collect evaluator feedback on contractor performance history and must be completed by references familiar with the offeror's prior contract work.
The survey requests basic contract information including the offeror's name, contract number, contract type and dollar value, and a brief description of work performed. Evaluators rate contractor performance across twelve dimensions using a five-point scale: Outstanding (O), Above Average (A), Satisfactory (S), Marginal (M), and Unacceptable (U). The evaluation criteria assess 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 direction, problem notification, corrective action history, likelihood of contract award renewal, and customer satisfaction with deliverables. The form provides space for detailed comments supporting each rating and requires the evaluator to provide their name, signature, title, company affiliation, telephone number, and completion date. Completed surveys should be emailed to Jason.Condiff@va.gov to establish the offeror's performance history for evaluation purposes.
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Attachment D.5 - Past Performance Survey Solicitation Number 36C25525Q0561
PAST PERFORMANCE SURVEY
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
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
Attachment D.3 - Past Performance Survey Solicitation Number 36C25525Q0561
Additional Comments:
Name of Evaluator: ____________________________
Signature of Evaluator: _________________________
Title: _______________________________________
Company: ___________________________________
Telephone No.: _______________________________
Date: ________________
Your assistance is requested by the Department of Veterans Affairs to assist with establishing the performance history for the Company (Offeror) named above. In efforts to expedite receipt of the requested information, please email the complete past performance questionnaire(s) to: Jason.Condiff@va.gov
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 mailto:Jason.Condiff@va.gov
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