D.8 Past Performance Questionnaire.pdf
PDF 152 KB Posted
- Attached to
- Q522--Teleradiology Services - Dayton VAMC
- Solicitation number
- 36C25026Q0444
About this file
This is a Past Performance Questionnaire template for evaluating contractor performance on a Department of Veterans Affairs teleradiology services contract (RFQ 36C25026Q0444). The questionnaire is completed by previous or current purchasers of the contractor's services and submitted directly to the Contract Specialist, Karen Williams, at Karen.Williams4@va.gov no later than the solicitation closing date.
The form requests evaluator information, details about the contract being evaluated (contract number, dollar value, performance dates, and work description), and an overall rating for the company. Evaluators must rate the contractor on ten specific performance criteria using a five-point scale: Outstanding (O), Above Average (A), Satisfactory (S), Marginal (M), or Unacceptable (U). These criteria assess contract compliance, timely report submission, ability to hire and maintain qualified personnel, schedule performance, responsiveness to technical direction, flexibility with changing needs, problem notification, and whether cure notices or terminations were issued. The form also includes yes/no questions regarding willingness to award future contracts and customer satisfaction. Evaluators must provide detailed supporting comments for each rating and can include additional comments. The completed questionnaire must be signed and dated by the evaluator. Comments are treated as confidential source selection information and will not be shared with the contractor or parties outside the Department of Veterans Affairs.
View the file
Other files
Show all 11
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
ATTACHMENT D.8 PAST PERFORMANCE QUESTIONNAIRE
Reference RFQ: 36C25026Q0444 – Teleradiology Services
INSTRUCTIONS: The Network Contracting Office (NCO) 10 is considering the Company (Offeror) listed below for award of a Department of Veterans Affairs Contract. You have been identified as a previous/current purchaser of the Company’s services, and your assistance with establishing the performance history for the Company is requested. Please note that your comments are considered source selection information and will not be shared in any way with the Company or any party outside the Department of Veterans Affairs.
This survey should be completed by an evaluator with sufficient knowledge of the Company’s performance and then send it directly to the Contract Specialist via email at Karen.Williams4@va.gov no later than the closing date and time of the solicitation. The Company (Offeror) should provide this information to you.
Information of the Company (Offeror) being evaluated:
Company Name: ________________________________________
Company Address: ________________________________________
Information of the Evaluator:
Evaluator Name and Title: _________________________________________
Company Name: _________________________________________
Phone Number: _________________________________________
Address: _________________________________________
Information of the Contract:
Contract Number: _________________________________________
Dollar Value: _________________________________________
Dates of Performance: _________________________________________
Brief Description of Work:______________________________________________________________
OVERALL RATING FOR THIS COMPANY IS:________________________________
mailto:Karen.Williams4@va.gov
Please provide supporting comments for each question below explaining the reasoning the particular rating was given.
“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 submitted timely per the contract requirements? O A S M U
3. To what extent did the contractor demonstrate ability to hire, maintain, or replace if necessary qualified key personnel during contract period?
O A S M U
4. To what extent was contractor able to meet the performance schedule? O A S M U
5. To what extent was the contractor responsive to technical directions? 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 did contractor notify you of problems or potential problems? O A S M U
8. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain
Yes No
9. Would you award another contract to the party being evaluated? If not, please explain: Yes No
10. Was the customer satisfied with the services provided? If not, please explain:
Yes No
Additional Comments:
Signature of Evaluator:_____________________________________________
Name of Evaluator:_______________________________________________
Date:____________
File details come from the government source that posted it. Updated .