Past Performance Questionaire 36C10F23R50003.pdf

Attachment

PAST PERFORMANCE QUESTIONNAIRE

The Department of Veterans Affairs Office of Construction and Facilities Management (CFM) is evaluating the Past Performance of Offeror listed below under Solicitation No. 36C10F23R50003, VA IDEA Survey Facilities Accessibility.

Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the company’s ability to perform the work as described in the solicitation. Please complete the enclosed questionnaire as thoroughly as possible. Space is provided for comments.

In addition to submitting this questionnaire, the VA CFM may contact you in order to obtain any additional information regarding a contract award.

Please email your completed questionnaire to ronald.ferrer@va.gov, attention Ronald Ferrer by the due date and time specified for receipt of offers.

If you have questions regarding the attached questionnaire, or require assistance, please email Ronald Ferrer at ronald.ferrer@va.gov .

Past Performance Information:

Name and Address of Company (Offeror) being evaluated:

Contract Number/Delivery or Task Order Number, Title, & Location of project the Offeror performed:

Evaluator: (The following information will assist in the analysis of the data. Information will be kept confidential)

Name of Evaluator:

Address:

Phone Number:

Position held or function in relation to project:

Rating: Please evaluate the past performance using only the following ratings without variation. DO NOT RATE ON A “+” OR “-“ SCALE. If a “+” or “-“ is used, the rating without the "+" or "-" will be applied. In addition to the ratings, please provide a short narrative in the appropriate block or in the remarks section of this form.

“O” Outstanding The Offeror’s performance met contractual requirements and exceeded many requirements to the

Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the offeror were highly effective.

“E” Excellent The Offeror’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the offeror were effective.

“A” Acceptable The Offeror’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the offeror were satisfactory.

“M” Marginal Performance did not meet some contractual requirements. Performance indicated that there are some potential risks associated with the quality products, timeliness of service, and contract performance.

“U” Unacceptable Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the offeror has yet to identify corrective actions or the offeror’s proposed actions appear only marginally effective or were not fully implemented.

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Please rate and provide any supporting information/comments for the following:

1. The relationship between the Architect-Engineer firm and client/customer contract team:

O E A M U

2. The Architect-Engineer firm’s management and coordination of consultants / subcontractors:

3. Overall corporate management, integrity, reasonableness, and cooperative conduct:

4. Quality of work: O E A M U

5. Quality control procedures and execution: O E A M U

6. Management and adherence to the performance schedule and cost limits: O E A M U

7. Ability/actions to improve schedule problems, if applicable:

8. Compliance with labor and safety standards. Yes No

9. Was the customer satisfied with the end product? If no, please explain. Yes No

10. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results?

Yes No N/A

11. Additional remarks:

12. Overall rating for this firm: O E A M U

Signature of Evaluator:

Date:

PLEASE NOTE: Architect-Engineer firm may be advised of adverse remarks and given the opportunity to respond in accordance with Federal Acquisition Regulation requirements.