PAST PERFORMANCE 36C24525Q0341 Att 5.pdf

Attachment 5

PAST PERFORMANCE QUESTIONAIRE

PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION NUMBER: 36C24525Q0341

The offeror shall provide the following questionnaire three examples who can attest to the offeror’s performance covering contracts or jobs that are recent, that is within Three years, and relevant, that is of the same type and scope of work. The offeror shall provide a list of these references, including the company/agency name, Point of Contact (POC), and telephone number or email address of the POC as part of their quote in order to be considered for award. Information to substantial the relevancy and recency regarding the references must also be included. Offerors should instruct their chosen references that completed questionnaires must be submitted by the exact date and time specified for receipt of offers, that is, July 25, 2025, 1400 EST, to Crystal S. Hinton, Department of Veterans, VA Medical Center, email: crystal.hinton@va.gov

PART 1: Shall be completed by the prospective contractor prior to forwarding to prospective Contractor's past performance reference.

1. Prospective Contractor's Name and Address

2. Prospective Contractor's Point of Contact with Name and Title

3. Prospective Contractor's Telephone Number (with area code)

4. Prospective Contractor's E-mail Address and/or facsimile Telephone Number

5. Prospective Contractor's Client, Firm or Government Agency Reference Name and Address

6. Prospective Contractor's Client, Firm or Government Agency Reference Telephone Number (with area code) mailto:crystal.hinton@va.gov

7. Contract Number of the Work Performed by the Prospective Contractor for Client, Firm or Government Agency_________________________________________________________

8. Brief Description of Relevancy of Work Involved

9. Contract/Order Period of Performance (list original contract periods such base year and 3 option periods)

PART 2: Shall be completed by Prospective Contractor's Client, Firm or Government Agency Reference.

1. Name and Title of Reference

2. Signature of Reference

3. Date

4. Name of Client, Firm or Government Agency Reference

5. Telephone Number

6. Facsimile Telephone Number

7. Reference E-mail Address

RATING DEFINITIONS FOR BEST VALUE TRADE-OFF:

Outstanding: Substantial confidence based on the offeror’s recent/relevant performance record. The Government has a high expectation that the offeror will successfully perform the required effort.

Acceptable: Satisfactory confidence based on the offeror’s recent/relevant performance record to successfully perform the required effort.

Marginal: Limited confidence based on the offeror’s recent/relevant performance record; the Government has a low expectation that the offeror will successfully perform the required effort.

Unacceptable: No confidence based on the offeror’s recent/relevant performance record. The Government has no expectation that the offeror will be able to successfully perform the required effort.

Neutral: Unknown confidence (neutral). No recent/relevant performance record is available, or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

QUALITY OF SERVICES

Evidence of Compliance with Contract Requirements:

Rate the contractor’s compliance with contract terms, conditions or requirements.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Accuracy of Reports:

Rate the contractor’s accuracy of the contractor reports

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Technical Excellence:

Rate the contractor’s technical ability.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Quality Workmanship:

Rate the contractor’s quality of workmanship.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Resolution of Problems:

Rate the contractor’s ability to resolve any unforeseen problems.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

TIMELINESS OF SERVICE

Delivery schedule:

Rate the contractor’s ability to provide continuous, on-time delivery in accordance with the established delivery schedule.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional): ______________________________________________________________

BUSINESS RELATIONS

Reasonable and Cooperative Behavior:

Rate the contractor’s reasonable and cooperative behavior.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Flexibility:

Rate the Contractor’s Flexibility.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Effective Conflict Resolutions:

Rate the contractor’s ability to resolve conflict.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Ability to Handle Government Requests for Change:

Rate the contractor’s ability to respond to changes.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

Communication:

Rate the contractor’s communication of performance progress, to include any notification of potential problems.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

CONTRACTOR’S OVERALL RATING:

Rate the contractor’s overall performance.

□ Outstanding

□ Acceptable

□ Marginal

□ Unacceptable

□ Neutral

Comments (Optional):

PAST PERFORMANCE QUESTIONAIRE