Exhibit K - Contractor Past Performance Survey.pdf
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- Attached to
- Vet Center space needed in Melbourne FL
- Solicitation number
- 36C24W2R0061
- Issued by
-
Department of Veterans Affairs
About this file
This is a Past Performance Questionnaire template issued by the Department of Veterans Affairs (VA) to evaluate contractor performance on existing or past contracts as part of the evaluation process for new VA solicitations.
The questionnaire is completed by the contracting officer or authorized government representative who directly observed the contractor's performance. It requests identification information including the contractor representative name, company name, address, contract number, award date, and work location/description. Respondents must provide their signature, name, title, telephone, and email. The completed evaluation must be submitted to Shanel.joe@va.gov by a specified deadline, with confidentiality of evaluator identity maintained per FAR 15.306(e)(4). The questionnaire covers six evaluation areas: (1) Contractor Rating using a five-point scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory); (2) Quality of Work, assessing compliance with lease requirements, project expectations, maintenance issues, safety standards, and defects; (3) Response Timing, rating timeliness in correcting deficiencies and submitting required documentation; (4) Cost Control, including original contract amount, deductions for defective work, and cost management efforts; (5) Business Management, evaluating on-site personnel and subcontractor management, quality control, and coordination; and (6) Overall Rating of Contractor performance. Each section provides space for additional comments to support ratings.
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Text version
PAST PERFORMANCE AND QUESTIONNAIRE
Date:
From:
To:
Re: Past Performance Questionnaire
Our firm is competing for a requirement solicited by the Department of Veterans Affairs (VA). In accordance with Federal Acquisition Regulations (FAR), the evaluation of our firm's past performance will be included in the award evaluation decision to be made by the VA. Your frank and candid response to this questionnaire will assist the evaluation team in this process.
Please note that while the responses of this questionnaire may be released to our firm by the VA, FAR
15.306(e) (4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained.
This survey should be completed by the individual most knowledgeable of our firm's day-to-day operations and the overall condition of the service rendered. However, that individual is encouraged to supplement their own knowledge of our performance with the judgment of others in your organization.
Completed evaluations may be scanned and emailed to Shanel.joe@va.gov. Completed evaluations must be received no later than close of business on _________________.
If you have any questions regarding this please contact Shanel Joe via email at Shanel.joe@va.gov
Thank you for your valuable input and assistance.
Signature
Contractor Representative Name:
Contractor Company Name:
Contractor Address:
Contract Number:
Date of Award:
Location and Description of Work:
mailto:javier.correaochoa@va.gov mailto:Javier.correaochoa@va.gov
1. Contractor Rating:
Please place an “X” on the circle for the rating that best applies to the work performed and provide responses or additional comments accordingly.
Exceptional: Significantly exceeds lease requirements to benefit the owner. Performance in the area indicated was accomplished with few minor problems which were effectively corrected.
Very Good: Meets all lease requirements and exceeds some to benefit of the owner. Performance in the area indicated was accomplished with few minor problems which were effectively corrected.
Satisfactory: Meets all lease requirements. Performance in the area indicated was accomplished with some minor problems which appear to be adequately corrected.
Marginal: Does not meet some lease requirements. Performance in the area indicated reflects a serious problem which has been minimally corrected, if at all.
Unsatisfactory: Does not meet lease requirements and recovery is not likely in a timely or cost-effective manner. Performance in the area indicated contains serious problem(s) which have been ineffectively corrected.
2. Quality of Work
a) Did the contractor comply with all lease requirements? O YES O NO
b) Did the completed project meet your expectations? O YES O NO
c) Is there unexpected maintenance activity? O YES O NO
d) Has unexpected maintenance activity disrupted tenant's operations? O YES O NO
e) Have latent defects been found since project completion? O YES O NO
f) How would you rate the contractor's compliance with safety standards?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
g) To what extent have maintenance problems occurred (roof leaks, HVAC levels, pest infestations, etc.)?__________________________________________________________________________
h) Would you select this firm again? O YES O NO
i) Additional Comments
3. Response Timing
a) How would you rate the contractor's timeliness in correcting any deficiencies in regards to maintenance problems (roof leaks, HVAC levels, pest infestations, etc.)?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
b) How would you rate the contractor's timeliness in submitting required reports, schedules, and documentation?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
c) Additional Comments
4. Cost Control
a) Amount of Original Contract $______________________
b) Were deductions taken for unperformed or defective work?
O Frequently O Rarely O Never
c) How would you rate the contractor's efforts in controlling costs, especially in regards to modifications to the contract?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
d) Additional Comments
5. Business Management
a) How would you rate the contractor's on-site management of personnel and subcontractors?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
b) How would you rate the contractor's onsite quality control?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
c) How would you rate the contractor's management and coordination of subcontractors?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
6. Overall Rating of Contractor
a) What is your overall rating of the contractor 's performance?
O Exceptional O Very Good O Satisfactory O Marginal O Unsatisfactory
b) Additional Comments
Evaluated by:
Signature:_________________________________________ Date: ____________________
Name of Evaluator :__________________________________________
Title of Evaluator:___________________________________________
Telephone: ________________________________________________
E-mail: ____________________________________________________
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