D4 - Past Performance Questionaire.docx
DOCX document 18 KB Posted
- Attached to
- G004--14 Bed Transitional Housing & Support Services Homeless Veteran Program, Dallas, TX
- Solicitation number
- 36C25723Q1179
About this file
This document contains a past performance questionnaire for a contractor being considered for award of a contract to provide community based residential treatment services and transitional housing for homeless veterans with substance abuse and/or mental health disorders. The contractor would provide rapid placement of veterans referred by the VA in a safe residential treatment setting while addressing complex needs through on-site clinical treatment and case management services. The questionnaire evaluates the contractor's performance on management effectiveness, quality of service and workmanship, timeliness and adherence to schedules, and customer satisfaction. Respondents are asked to rate the contractor's performance as exceeds, meets, or fails expectations in these areas and provide any relevant comments. The questionnaire must be completed and returned by June 16, 2023.
The related federal contract opportunity is for a 14 bed transitional housing and support services program for homeless veterans in Dallas, Texas, to be awarded by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17.
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Other files
| File | Type | Posted |
|---|---|---|
| D7 - INSPECTION CHECKLIST.pdf | ||
| D1 - WD 15-5227 Rev 19 12.27.22 (Dallas County).txt | TXT text file | |
| D5 - VCB Incident Report.docx | DOCX document | |
| 36C25723Q1179_1.docx | DOCX document | |
| D6 - QASP - 3 May 23 (1).pdf | ||
| D2 - Contractor Rules of Behavior.pdf | ||
| D3 - ADA Checklist.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
The below-named contractor is being considered for award of a contract for Solicitation No. 36C257-23-R-0040 for community based residential treatment services and transitional housing for Homeless Veterans with substance abuse and/or mental health disorders (thereafter referred to as HCHV) for the homeless to be furnished to the Department of Veterans Affairs Medical Center (VAMC), servicing the Texas Valley Coastal Bend VA Health Care System. VA intends to engage a Contractor to provide rapid placement of VA-referred Veterans in a safe, residential treatment setting while addressing Veterans’ complex needs through on-site clinical treatment and case management services.
A primary consideration in our selection process is the contractor’s history of performance of similar efforts. PLEASE COMPLETE FORM and RETURN TO: noel.ramirez2@va.gov. FORMS MUST BE RECEIVED BY THE CONTRACTING OFFICER NLT 16 JUNE 2023 (1200 PM, Mountain Time)
A. GENERAL INFORMATION
Contractor’s Name: ___________________________________________________________ Address: _____________________________________________________________________ Telephone Number: _____________________ Point of Contact: ________________________
B. RESPONDENT INFORMATION
Name: _______________________________ Title: ________________________________ Organization & Address: ________________________________________________________ Telephone: __________________ Fax: ________________ Email: _____________________
C. CONTRACT INFORMATION
Contract Number/Title: __________________________________________________________ Period of Performance: ________________ Current Dollar Amount of Contract: ___________ Services Performed: ____________________________________________________________
D. PERFORMANCE INFORMATION
Choose the category on the below scale that most accurately describes the contractor’s performance or situation.
| E |
| M |
| F |
| Exceeds |
| Meets |
| Fails-please note the issue/problem/resolution |
Please use the above ratings to describe the contractor’s performance in the following areas:
1. MANAGEMENT EFFECTIVENESS
| a. Contractor provided experienced managers and supervisors with technical and administrative abilities to meet contract requirements |
| E M F |
| b. Contractor handled staff integrity issues appropriately |
| E M F |
| c. Contractor’s overall management effectiveness |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. QUALITY OF SERVICE AND WORKMANSHIP
| a. Contractor maintained safe, clean, and acceptable residential treatment facility. |
| E M F |
| b. Contractor provide appropriate treatment plans for individual treatment facility. |
| E M F |
| c. Contractor provided acceptable/immediate response when issues arose. |
| E M F |
| d. Contractor’s overall quality of service. |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. TIMELINESS/ADHERENCE TO SCHEDULES
| a. Contractor responded to technical support issues in a timely manner |
| E M F |
| b. Overall contractor timeliness |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. CUSTOMER SATISFACTION
| a. Contractor maintained a professional working relationship |
| E M F |
| b. Contractor was reasonable and cooperative in resolving any customer complaints |
| E M F |
| c. Contractor was flexible in responding to customer requirements |
| E M F |
| d. Overall customer satisfaction |
| E M F |
COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
E. If a government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? __________ if yes, please describe:
F. If given the opportunity, would you award another contract to this contractor? Please explain response below.
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