Exhibit O - Past Performance Questionnaire-Oscoda.pdf

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Attached to
X1AA--Oscoda CBOC - Amendment 2 Question
Solicitation number
36C25024R0208
Issued by

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This document is a Past Performance Questionnaire for the Oscoda VA Clinic project, associated with Solicitation Number 36C25024R0208. The form is designed for collecting detailed performance feedback about a contractor's performance across multiple assessment categories, including compliance with lease requirements, quality of services, timely delivery, business relations, management of key personnel, reliability, customer support, and overall performance. The questionnaire requires the reference to complete and submit the form directly to the VA's Contract Officer, Lisa.Newlin@va.gov, no later than 12:00 PM Local Time on 03/27/2025, with a specific subject line format. The form provides a comprehensive rating scale from Unsatisfactory to Exceptional for each assessment category, allowing a thorough evaluation of the contractor's past performance.

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1. NAME OF FIRM BEING RATED: _____________________________________________________________ NAME OF PRIMARY CONTACT AT FIRM BEING RATED: ______________________________________________

2. 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: ______________________

3. NAME OF ASSESSING OFFICIAL: ______________________________________________________________ EMAIL: ______________________________ PHONE NUMBER: ____________________________________ ASSOCIATION WITH FIRM BEING RATED (including role): ____________________________________________ CONTRACT OR ORDER NUMBER (if applicable): ___________________________________________________

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

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)

5. ADDITIONAL COMMENTS:

PAST PERFORMANCE QUESTIONNAIRE

RLP No. ___________________________ Project Name: _______________________

COMPLETED BY:

SIGNATURE:

TITLE:

INSTRUCTIONS FOR REFERENCES COMPLETING THIS QUESTIONNAIRE:

VA requests that the reference completes this questionnaire and submits it directly back to VA’s Contract Officer, at Lisa.Newlin@va.gov no later than _______PM Local Time on ___________________, with a subject line that reads “RLP 36C25024R0208 [Name of Offeror], Completed Past Performance Questionnaire”.

The Government reserves the right to verify all information on this form.

1 NAME OF FIRM BEING RATED NAME OF PRIMARY CONTACT AT FIRM BEING RATED:
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:
NAME OF ASSESSING OFFICIAL:
EMAIL:
PHONE NUMBER:
ASSOCIATION WITH FIRM BEING RATED including role:
CONTRACT OR ORDER NUMBER if applicable:
Unsatisfactorya COMPLIANCE WITH LEASE REQUIREMENTS:
Marginala COMPLIANCE WITH LEASE REQUIREMENTS:
Satisfactorya COMPLIANCE WITH LEASE REQUIREMENTS:
Very Gooda COMPLIANCE WITH LEASE REQUIREMENTS:
Exceptionala COMPLIANCE WITH LEASE REQUIREMENTS:
NAa COMPLIANCE WITH LEASE REQUIREMENTS:
Unsatisfactoryb QUALITY OF SERVICES:
Marginalb QUALITY OF SERVICES:
Satisfactoryb QUALITY OF SERVICES:
Very Goodb QUALITY OF SERVICES:
Exceptionalb QUALITY OF SERVICES:
NAb QUALITY OF SERVICES:
Unsatisfactoryc TIMELY DELIVERY OF SERVICES:
Marginalc TIMELY DELIVERY OF SERVICES:
Satisfactoryc TIMELY DELIVERY OF SERVICES:
Very Goodc TIMELY DELIVERY OF SERVICES:
Exceptionalc TIMELY DELIVERY OF SERVICES:
NAc TIMELY DELIVERY OF SERVICES:
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:
5 ADDITIONAL COMMENTS:
Name of Firm:
Contact Name:
RLP No: 36C25024R0208
Project Name: Oscoda VA Clinic
Completed by:
Title:
Time: 12:00
Date: 03/27/2025

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