D.5 Attachment Past Performance Questionnaire.pdf
PDF 186 KB Posted
- Solicitation number
- 36C25026Q0466
About this file
This is a Past Performance Questionnaire for Request for Quotation (RFQ) 36C25026Q0466 issued by the Louis Stokes Cleveland VA Medical Center for HCHV Services. The questionnaire is designed to be completed by past clients or contracting officers who have direct knowledge of an offeror's performance on previous contracts. Responses must be submitted via email to angela.higgins@va.gov on or before August 3, 2026, rather than as hard copies.
The questionnaire requests evaluators to rate the offeror's past performance across eleven specific criteria using a four-tier rating scale: Outstanding (O), Above Average (A), Satisfactory (S), or Unacceptable (U). The evaluation areas include timely completion of scheduled services per the Performance Work Statement, compliance with contractual terms and conditions, provision of experienced personnel, ability to hire and maintain qualified staff, quality control and inspection procedures, timely deficiency correction, regulatory and industry standards compliance, responsiveness to urgent requests, problem-solving capability, and timeliness and accuracy of documentation and invoices. Evaluators must also provide an overall quality rating and indicate whether they would award similar contracts to the offeror, along with explanatory narratives for each assessment. The form requires completion of offeror name, contract number, contract title/description, period of performance, and scope of work summary, followed by the assessor's name, signature, company/agency affiliation, position title, date, phone, email, and fax information.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PAST PERFORMANCE QUESTIONNAIRE
REQUEST FOR QUOTATION (RFQ) 36C25026Q0466
HCHV Services
Louis Stokes Cleveland VA Medical Center
MESSAGE TO THE EVALUATOR: Your assistance is requested by Angela Higgins, Contracting Officer to assist with establishing the performance history for the Company (Offeror) named below. In efforts to expedite receipt of the requested information, the Contracting Officer respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to:
angela.higgins@va.gov. If enough space is not provided, then please attach additional information to this questionnaire. Please provide the survey back on or before August 3, 2026.
1. Name of Offeror /Agency:
Contract Number:
Title/Description of Contract:
Period of Performance:
Based upon the definitions below, indicate your assessment of the offeror’s performance. Your assessment should consider the offeror’s performance in accordance with the contractual requirements. Please include the period of performance and contract value:
2. Brief description of scope of work:
EVALUATION: Please rate the offeror using the guide and the pull-down menus in the evaluation table below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.
ASSESSMENT DEFINITION
Outstanding (O) The Offeror’s performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the offeror were highly effective.
Above Average (A) The Offeror’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the offeror were effective.
Satisfactory (S) The Offeror’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the offeror were satisfactory.
Unacceptable (U) Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the offeror has yet to identify corrective actions or the offeror’s proposed actions appear only marginally effective or were not fully implemented.
Completed scheduled services in a timely manner per the Performance Work Statement (PWS).
Choose an item.
Compliance with contractual Terms and Conditions. Choose an item.
Provided experienced personnel with sufficient technical and administrative abilities needed to meet contract requirements.
Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.
Provided effective quality control and/or inspection procedures to meet contract requirements.
Corrected deficiencies in timely manner and pursuant to the offeror’s quality control procedures.
Exhibited knowledge of and compliance with Government (or other) regulations and industry standards.
Effectively responded to urgent requests in a timely manner per the Performance Work Statement (PWS).
Solved contract performance problems without extensive guidance from procurement or technical personnel.
Provided timely and accurate documents, records, and invoices as required by the contract.
Rate the Offeror’s OVERALL quality of performance under this contract Choose an item.
Would you award similar contracts to this offeror? Please provide explanation for response.
EXPLANATION OF OVERALL RATING GIVEN:
ADDITIONAL COMMENTS (use additional pages as required)
ASSESSOR NAME AND INFORMATION
Name & Signature of Assessor’s:
Company/Agency: Date:
Position Title/Grade: Contracting Officer Phone:
Email: Fax:
File details come from the government source that posted it. Updated .