Exhibit N- Past Performance Questionaire-Cleveland.pdf
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- Attached to
- Cleveland, WI VA CBOC New Replacing Lease
- Solicitation number
- 36C25225R0056
About this file
This document is a Past Performance Questionnaire (Exhibit N) for Request for Lease Proposal (RLP) 36C252-25-R-0056 issued by the Department of Veterans Affairs (VA). The questionnaire is designed to evaluate a contractor's performance across multiple dimensions, including quality of work, response timing, cost control, and business management. Respondents are asked to rate the contractor's performance on a scale from Exceptional to Unsatisfactory, with sections covering compliance with lease requirements, maintenance issues, timeliness, cost control, personnel management, and overall performance.
The document requires completed evaluations to be submitted via email to Julie.lecourt@va.gov and Joshua.jackson4@va.gov no later than close of business on 12/11/2025. The questionnaire emphasizes confidentiality, noting that while responses may be released to the evaluated firm, the names of individuals providing feedback will be kept confidential. Key areas of evaluation include project compliance, safety standards, maintenance problem resolution, cost control, on-site management, quality control, and subcontractor coordination. The form provides space for detailed ratings and additional comments to comprehensively assess the contractor's performance.
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RLP 36C252-25-R-0056 EXHIBIT N - REQUEST FOR 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 Julie.lecourt@va.gov and
Joshua.jackson4@va.gov.
Completed evaluations must be received no later than close of business on 12/11/2025.
If you have any questions regarding this please contact Julie Le Court at Julie.lecourt@va.gov and
Joshua.jackson4@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:Julie.lecourt@va.gov mailto:Joshua.jackson4@va.gov mailto:Julie.lecourt@va.gov mailto:Joshua.jackson4@va.gov mailto:Javier.correaochoa@va.gov
RLP 36C252-25-R-0056 EXHIBIT N - REQUEST FOR PAST PERFORMANCE AND QUESTIONNAIRE
PAST PERFORMANCE QUESTIONNAIRE
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
RLP 36C252-25-R-0056 – EXHIBIT N- REQUEST FOR PAST PERFORMANCE AND QUESTIONNAIRE
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?
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?
b) Additional Comments:
Evaluated by:
Signature: Date:
Name of Evaluator :
Title of Evaluator:
Telephone:
E-mail:
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