D6. Past Performance Questionaire.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C25721R0010
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Other files
| File | Type | Posted |
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| D8. Wage Determination-1994-0761.pdf | ||
| D4. Incident Report.docx | DOCX document | |
| D1.Contract Personnel Assigned to HCHV Contract.docx | DOCX document | |
| D2. ADA Checklist.pdf | ||
| D3. Contractor Rules of Behavior Agreement.pdf | ||
| D5. Facility HCHV Contracted Provider Inspection Blank Form (2).pdf | ||
| 36C25721R0010.docx | DOCX document | |
| D7. Quality Assurance Surveillance Plan-HCHV Program.pdf |
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PAST PERFORMANCE QUESTIONNAIRE
The below-named contractor is being considered for award of a contract for Solicitation No. 36C25721R0010 for Housing Services and Residential Care Services (thereafter referred to as HCHV) for the homeless to be furnished to the Department of Veterans Affairs Medical Center (VAMC), servicing the Amarillo 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: duryea.williams@va.gov. FORMS MUST BE RECEIVED BY THE CONTRACTING OFFICER NLT December 01, 2020 (3:00pm, Mountain Standard 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.
File details come from the government source that posted it. Updated .