Exhibit K- PP Questionnaire.pdf

169 KB Posted

Attached to
Laramie, WY CBOC Lease - Amendment 4: Extension of RLP Submission Due Date
Solicitation number
36C24W24R0075
Issued by

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This document is a Past Performance Questionnaire template. It requests feedback on the past performance of a contractor across various assessment categories, including quality of services, schedule, cost control, business relations, management of key personnel, reliability, customer support, and overall performance. The questionnaire is to be filled out by an assessing official who has previous experience working with the contractor being rated. The assessment categories are rated on a scale from "Unsatisfactory" to "Exceptional." The questionnaire also provides space for the assessing official to provide additional comments.

This Past Performance Questionnaire is related to the federal contract opportunity for a leased facility to house a Community Based Outpatient Clinic (CBOC) for Veterans in Laramie, WY. The solicitation number is 36C24W24R0075 and the Department of Veterans Affairs is the procuring agency.

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Past Performance Questionnaire

1. NAME OF FIRM/AGENCY PROVIDING FEEDBACK:

PROJECT NAME:

PERIOD OF PERFORMANCE: CONTRACT TYPE (if applicable):

CONTRACT AWARD DATE: CONTRACT COMPLETION DATE:

AWARDED VALUE: CURRENT CONTRACT DOLLAR VALUE:

2. NAME OF ASSESSING OFFICIAL:

EMAIL: PHONE NUMBER:

ASSOCIATION WITH FIRM BEING RATED (including role):

CONTRACT OR ORDER NUMBER (if applicable):

3. ASSESS THE FOLLOWING AREAS: (Check the appropriate box for each assessment category)

4 ADDITIONAL COMMENTS:

Assessment Categories Unsatisfactory Marginal Satisfactory Very Good Exceptional N/A

a. COMPLIANCE WITH LEASE REQUIREMENTS

b. QUALITY OF SERVICES

c. TIMELY DELIVERY OF SERVICES

d. BUSINESS RELATIONS

e. MANAGEMENT OF KEY PERSONNEL

f. RELIABILITY

g. CUSTOMER SUPPORT

h. OVERALL PERFORMANCE

i. OTHER AREAS:

(1)

(2)

1 NAME OF FIRMAGENCY PROVIDING FEEDBACK:
PROJECT NAME:
PERIOD OF PERFORMANCE:
CONTRACT TYPE if applicable:
CONTRACT AWARD DATE:
CONTRACT COMPLETION DATE:
AWARDED VALUE:
CURRENT CONTRACT DOLLAR VALUE:
2 NAME OF ASSESSING OFFICIAL:
EMAIL:
PHONE NUMBER:
ASSOCIATION WITH FIRM BEING RATED including role:
CONTRACT OR ORDER NUMBER if applicable:
Assessment Categories:
Unsatisfactorya QUALITY OF PRODUCT OR SERVICE:
Marginala QUALITY OF PRODUCT OR SERVICE:
Satisfactorya QUALITY OF PRODUCT OR SERVICE:
Very Gooda QUALITY OF PRODUCT OR SERVICE:
Exceptionala QUALITY OF PRODUCT OR SERVICE:
NAa QUALITY OF PRODUCT OR SERVICE:
Unsatisfactoryb SCHEDULE:
Marginalb SCHEDULE:
Satisfactoryb SCHEDULE:
Very Goodb SCHEDULE:
Exceptionalb SCHEDULE:
NAb SCHEDULE:
Unsatisfactoryc COST CONTROL:
Marginalc COST CONTROL:
Satisfactoryc COST CONTROL:
Very Goodc COST CONTROL:
Exceptionalc COST CONTROL:
NAc COST CONTROL:
Unsatisfactoryd BUSINESS RELATIONS:
Marginald BUSINESS RELATIONS:
Satisfactoryd BUSINESS RELATIONS:
Very Goodd BUSINESS RELATIONS:
Exceptionald BUSINESS RELATIONS:
NAd BUSINESS RELATIONS:
Unsatisfactorye MANAGEMENT OF KEY PERSONNEL:
Marginale MANAGEMENT OF KEY PERSONNEL:
Satisfactorye MANAGEMENT OF KEY PERSONNEL:
Very Goode MANAGEMENT OF KEY PERSONNEL:
Exceptionale MANAGEMENT OF KEY PERSONNEL:
NAe MANAGEMENT OF KEY PERSONNEL:
Unsatisfactoryf RELIABILITY:
Marginalf RELIABILITY:
Satisfactoryf RELIABILITY:
Very Goodf RELIABILITY:
Exceptionalf RELIABILITY:
NAf RELIABILITY:
Unsatisfactoryg CUSTOMER SUPPORT:
Marginalg CUSTOMER SUPPORT:
Satisfactoryg CUSTOMER SUPPORT:
Very Goodg CUSTOMER SUPPORT:
Exceptionalg CUSTOMER SUPPORT:
NAg CUSTOMER SUPPORT:
Unsatisfactoryh OVERALL PERFORMANCE:
Marginalh OVERALL PERFORMANCE:
Satisfactoryh OVERALL PERFORMANCE:
Very Goodh OVERALL PERFORMANCE:
Exceptionalh OVERALL PERFORMANCE:
NAh OVERALL PERFORMANCE:
Unsatisfactoryi OTHER AREAS:
Marginali OTHER AREAS:
Satisfactoryi OTHER AREAS:
Very Goodi OTHER AREAS:
Exceptionali OTHER AREAS:
NAi OTHER AREAS:
1:
Unsatisfactory1:
Marginal1:
Satisfactory1:
Very Good1:
Exceptional1:
NA1:
2:
Unsatisfactory2:
Marginal2:
Satisfactory2:
Very Good2:
Exceptional2:
NA2:
4 ADDITIONAL COMMENTS:

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