EXHIBIT N_ PastPerf Questionnaire.docx
DOCX document 42 KB Posted
- Solicitation number
- 36C24W26R0010
- Issued by
-
Department of Veterans Affairs
About this file
This document is a Past Performance Questionnaire for a VA contract (Solicitation Number 36C24W26R0010) related to a Mental Health Clinic lease in McAllen, Texas. The questionnaire is designed to collect comprehensive performance feedback from previous contract assessors, using a rating scale ranging from Exceptional (E) to Unsatisfactory (U), with neutral/unknown risk also possible. The assessment covers three primary evaluation areas: Quality of Service, Schedule Performance, and Business Relations, with multiple sub-categories including contractual compliance, delivery timeliness, cost control, invoice accuracy, business ethics, and customer relationship management.
The associated federal contract opportunity involves leasing approximately 17,088 rentable square feet for a VA Mental Health Clinic, with a proposed 10-year firm term and 10-year soft term. The solicitation is set aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) and requires proposal submission by February 20, 2026, at 4:00 p.m. local time. The lease is being administered by the Department of Veterans Affairs, with the specific goal of establishing a new mental health facility in McAllen, Texas to replace an existing lease.
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Text version
12/30/20
PAST PERFORMANCE QUESTIONNAIRE
SECTION A: Contractor Information (to be completed by the contractor for whom past performance information is being collected, prior to forwarding to assessors)
| Solicitation Number |
| 36C24W26R0010 |
| Project/Requirement |
| VA/CBOC in McAllen, TX |
| Customer/Agency |
| VHA |
1. Prospective Government Contractor’s ______________________________________
| Name and Address: | ______________________________________ | |
| ______________________________________ | ||
| ______________________________________ |
2. Contractor Point of Contact: ___________________________________________
3. Phone number (with area code): ___________________________________________
4. Assessor Contract Award number: _________________________________________
5. Description of Services provided under contract: ________________________________________________________________________
6. Contract award date: ___________ Contract Amount: Initial ___________Final ____
7. Period of Performance or Delivery Date: _________________________
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
8. Authorization is hereby granted to provide the information requested in this questionnaire to NCO 21 Network Contracting Activity, Jeffrey Deering, Lease Contracting Officer, via email at Jeffrey.deering@va.gov.
(Signature)
| _____________________________________________ | __________________________ | |
| (Name and Title of Authorizing Official) | (Date) |
SECTION B: Assessors Information (to be completed by assessors).
RATING SCALE Definitions Past Performance Ratings and Definitions
| E |
| Exceptional/Very Low Risk |
| Offer’s past performance record provides essentially no doubt that the offeror will successfully perform the required effort. |
| S |
| Satisfactory/Low Risk |
| Offer’s past performance record provides little doubt that the offeror will successfully perform the required effort. |
| M |
| Marginal/Moderate Risk |
| Offer’s past performance record, although satisfactory, provides some doubt that the offeror will successfully perform the required effort. |
| U |
| Unsatisfactory/High Risk |
| Offer’s past performance record provides substantial doubt that the offeror will successfully perform the required effort. |
| N |
| Neutral/Unknown Risk |
| The offeror has no relevant past performance record. A thorough search was unable to identify any past performance. Will not rate favorably or unfavorably. |
The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.
QUALITY OF SERVICE
1. Rate the contractor’s compliance with contractual requirements. _________ (E /S /M /U /N)
2. Overall rating of contractor quality of service. _________ (E /S /M /U /N)
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
SCHEDULE
1. Delivery of service was within required time period specified by contract requirements. _________ (E /S /M /U /N)
2. Rate the contractor’s ability to control cost and submit invoices.
Are invoices complete, accurate, and timely? _________ (E /S /M /U /N)
BUSINESS RELATIONS
1. Overall rating of contractor’s business practices (e.g., maintaining A positive working relationship, business ethics, timely and effectively Resolution of any problems, etc.) _________ (E /S /M /U /N)
2. Rate the working relationship between contractor’s management, and your company (i.e., contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer). _________ (E /S /M /U /N)
3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner. _________ (E /S /M /U /N)
4. Rate the contractor’s responsiveness to customer complaint resolution. _________ (E /S /M /U /N)
5. Overall rating of contractor’s business relations. _________ (E /S /M /U /N)
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
How would you feel about awarding another contract to this contractor? (Mark with an “X”)
| ______ | Would not hesitate to award another contract to this contractor. |
| ______ | Would most likely award another contract to this contractor. |
| ______ | Would think twice about awarding another contract to this contractor but would do so if no better alternative existed. |
| ______ | Do not wish to award another contract to this contractor. |
| ______ | Would not award another contract to this contractor. |
Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.
| Exceptional |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Neutral |
VII. General Comments:
ASSESSOR:
Identify your role in the contract award or administration and the period of your involvement.
| Role |
| Period of Involvement |
Contract Specialist/LEASE CONTRACTING OFFICER
Technical Project Lead/Project Officer
OTHERS
| ________________________________________ | ____________________________ | |
| (Signature) | (Date) |
(Typed or Printed Name) (Organization Name)
| ____________________________ | _________________________ | |
| (Phone Number) | (Email) |
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