PAST PERFORMANCE QUESTIONNAIRE 36C24226Q0504.pdf

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS FOR THE

PAST PERFORMANCE QUESTIONNAIRE

FOR OFFICIAL USE ONLY

CONTRACTOR INFORMATION (Information on the Company that you are evaluating)

A. Contractor Name:

B. Contractor's Address:

C. Point of Contact:

CONTRACT INFORMATION

IN ORDER TO DETERMINE RELEVANCY, AND RECENCY THE FOLLOWING DATA IS

REQUIRED. FAILURE TO PROVIDE THIS INFORMANTION MAY RENDER THE

PROPOSAL UNRESPONSIVE.

A. CONTRACT NUMBER:

B. CONTRACT TYPE:

C. AWARD DATE:

D. PERIOD OF PERFORMANCE:

E. TOTAL CONTRACT DOLLAR AMOUNT INCLUDING

OPTIONS, IF APPLICABLE:

F. SCOPE: PLEASE INCLUDE A BRIEF DESCRIPTION OF THE SERVICES PERFORMED TO

DETERMINE SIMILARITY OF SCOPE.

PAST PERFORMANCE QUESTIONNAIRE FOR

OFFICIAL USE ONLY

1. Please complete this questionnaire based on the following guidance:

a. For each question please select a rating as defined below from the drop down menu. Choose "N/A" from the drop down menu if you are unable to provide a rating for an area. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

Exceptional (E)

Very Good (VG)

Satisfactory (S)

Neutral (N)

Marginal (M)

Unsatisfactory (U)

Definition

Performance meets contractual requirements and exceeds many to the Government’s benefit.

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

No performance record identifiable (see FAR 15.305(a)(2)(iii) and (iv)).

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective

b. Handwritten remarks are encouraged. Space is provided at the end of the survey. If more space is needed, please provide information on a separate sheet of paper.

c. You are urged to supplement your own knowledge of the contractor's performance with the judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other contracts/programs that your activity has with this offeror.

2. Please return completed questionnaire no later than due date for submission of this solicitation via e-mail to:

US DEPARTMENT OF VETERANS AFFAIRS

Network Contracting Office (NCO) 02

ATTN: Tiffany Vazquez-Simon, Contract Specialist FDR Hospital – Montrose Campus

2094 Albany Post Road Montrose, NY 10548

EMAIL: tiffany.vazquez-simon@va.gov

Rating

NOTE: For statements indicating “Exceptional”, “Marginal” or “Unsatisfactory” please provide an explanation in the remarks section of the survey.

PAST PERFORMANCE

QUESTIONNAIRE FOR OFFICIAL

USE ONLY

1. Contractor's compliance with contractual terms and conditions.

2. Quality of contractor furnished reports/deliverables.

3. Overall rating of contractor's commitment to providing quality service.

4. Contractors ability to meet standards specified for performance.

5. Overall rating of contractor's quality of service.

TIMELINESS OF PERFORMANCE

1. Contractor's ability to meet specific response times and scheduled time frames for completion of specific tasks.

2. Contractor's responsiveness/timeliness for providing administrative reports/ documents required by the contract.

3. Contractor's timeliness in responding to emergency service requirements.

4. Overall rating of contractor's responsiveness/timeliness.

BUSINESS RELATIONS

1. Contractor's ability to identify problems and potential problems and promptly notify the Contracting Officer.

2. Contractor's ability to correct problems and prevent or mitigate potential problems in a timely manner.

3. Contractor's willingness to improve and correct noncompliance issues or concerns.

4. Extent to which the contractor has demonstrated reasonable and cooperative behavior.

5. Contractor's ability to use effective approaches and provide technical expertise and resources to solve contract problems.

6. Contractor's working relationship with the Contracting Officer, quality assurance personnel, and customers.

QUALITY OF SERVICE

7. Contractor's flexibility in satisfying the requirements of its customers.

8. Extent to which the contractor provided prompt and courteous service when responding to customer complaint.

9. Overall rating of customer satisfaction.

10. Overall rating of business relations.

MANAGEMENT OF KEY PERSONNEL

1. Contractor's ability to select and retain cooperative and effective key personnel, such as the contract manager and quality control personnel.

2. Extent key personnel were knowledgeable about contractual requirements.

3. Contractor's ability to meet appropriate staffing levels with qualified personnel in order to provide required services.

4. Contractor's ability to effectively manage subcontracts.

5. Overall rating of contractor's management of key personnel.

REMARKS CONCERNING CONTRACTOR’S OVERALL PERFORMANCE:

RESPONDENT’S PRINTED NAME:

RESPONDENT’S TITLE:

RESPONDENT’S SIGNATURE:

RESPONDENT’S PHONE NUMBER:

FOR OFFICIAL USE ONLY

THANK YOU FOR TAKING THE TIME TO COMPLETE AND RETURN THIS QUESTIONNAIRE!

Given what I know today about the contractor's ability to perform in accordance with this contract or order's most significant requirements, I recommend them for similar requirements in the future.