EXHIBIT B_Past and Present Performance Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO CONTRACTOR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes).

Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions below.

INSTRUCTIONS TO REFERENCE CONTACT

The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact.

Please complete this form in full (all areas shaded in light yellow, below). Once completed, please send the form to the Contract Specialist via email directly to:

Department of Veterans Affairs NCO 16 Contracting Office TO: Julius Jones, Contract Specialist REF: 36C25622R0140 Email Address: julius.jones@va.gov

Please return the completed form no later than the closing date of the solicitation. If you have any questions, please contact contracting specialist via email. Thank you for your assistance in this matter.

GENERAL INFORMATION [completed by Contractor]

Contractor Company Name Street Address

Contractor Point of Contact Name City

Point of Contact Phone Number State

Reference Project Title Zip Code Contract Period of Performance (start to finish): Email

Contract Number Contract Dollar Value

Description of Work

Role of Contractor on This Project ☒ Prime Contractor ☐ Sub-contractor ☐ Key Personnel mailto:melissa.westfall@va.gov

Solicitation No. 36C25622R0140 Construct Inpatient Dialysis–NLR

PN 598-18-107

Source Selection Information--See FAR 2.101 and 3.104

(check appropriate box)

RESPONDENT INFORMATION [completed by Reference Contact]

Company Name Street Address POC Name City Phone Number State Fax Number Zip Code Email

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2 in the applicable text box OR in the Remarks section, below (text box will expand to whatever extent is necessary).

1 2 3 4 5 6

UNSATISFACTORY MARGINAL SATISFACTORY VERY GOOD EXCEPTIONAL NEUTRAL

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance met contractual requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner.

No record of past performance or the record is inconclusive.i

The Contractor … 1 2 3 4 5 6

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Narrative:

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Narrative:

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

Narrative:

4. Home office participated in solving significant local problems.

Narrative:

5. Followed approved quality control plan.

Narrative:

PN 598-18-107

Source Selection Information--See FAR 2.101 and 3.104

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

Narrative:

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

Narrative:

8. Provided timely resolution of contract discrepancies Narrative:

9. Identified problems as they occurred.

Narrative:

10. Suggested alternative approaches to problems.

Narrative:

11. Displayed initiative to solve problems.

Narrative

12. Developed realistic progress schedules.

Narrative:

13. Met established project schedules.

Narrative:

14. Provided timely resolution of warranty defects.

Narrative:

15. Was responsive to contract changes.

Narrative:

16. Provided adequate project supervision.

Narrative:

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

Narrative:

18. Paid subcontractors/suppliers in a timely manner.

Narrative:

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

Narrative:

20. Cooperated with Government personnel after award.

Narrative:

21. How would you rate the contractor's overall performance?

Narrative:

22. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

☐ YES ☐ NO

23 Would you award another contract to this contractor? If not, please explain in “remarks.”

☐ YES ☐ NO

24 To the best of your knowledge, is the contractor rated in CPARS? ☐ YES ☐ NO

REMARKS (Please use as much space as is needed – the box will expand as you type).

PN 598-18-107

Source Selection Information--See FAR 2.101 and 3.104

Printed Name Title

Signature