Past Performance Questionnaire 36C24823Q1289.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C24823Q1289
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Other files
| File | Type | Posted |
|---|---|---|
| Price Schedule updated.xlsx | XLSX spreadsheet | |
| 36C24823Q1289 0001.docx | DOCX document | |
| PRICE SCHEDULE.xlsx | XLSX spreadsheet | |
| 36C24823Q1289.pdf | ||
| 36C24823Q1289_1.docx | DOCX document | |
| PWS Dental Prosthesis.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
The Bay Pines VA Healthcare System is considering the Quoter listed below for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the Quoter’s experience. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation prohibits the release of the names of individuals providing reference information about Quoter’s past performance. This survey should be completed by an evaluator with sufficient familiarity of the Quoter’s performance and returned to the contracting office by the evaluator no later than June 15, 2023, at 1:00 PM EST by e-mail to melva.stennis@va.gov.
Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address and telephone number.
| b. | Include the contractor’s name and address, the title and/or description of the type of work performed the award number, the value of the contract (including options), the award and completion date of the project and the type of award/solicitation. |
| c. | Use the rating scale found on the bottom left corner of the questionnaire to rate each performance element. |
| d. | Comments are encouraged and would be appreciated. Clear handwritten responses are sufficient. |
Thank you for your time and participation.
PAST PERFORMANCE SURVEY
36C24823Q1289 Dental Prostheses Laboratory Products and Services
YOUR NAME & TITLE
YOUR ORGANIZATIONAL ADDRESS
TEL NO.
FAX :
E-MAIL:
CONTRACTOR’S NAME & ADDRESS
TITLE OR DESCRIPTION OF REQUIREMENT:
CONTRACT NUMBER:
CONTRACT VALUE (INCLUDING OPTIONS):
| CONTRACT TYPE (circle one): | |
| FIXED PRICE | COST + FEE |
| COMPETITIVE | NON-COMPETITIVE |
SET-ASIDE
SEALED BID NEGOTIATED
SEALED BID NEGOTIATED
CONTRACT AWARD & COMPLETION DATE:
| PAST PERFORMANCE ELEMENT |
| RATING |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| NA |
1. Contractor demonstrated a thorough understanding of technical requirements of the contract/task.
Comments:
2. Contractor anticipated/identified and resolved problems effectively.
Comments:
3. Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively.
Comments:
4. Contractor provided the necessary skilled personnel to perform the required work.
Comments:
5. Contractor retained the necessary skilled personnel and maintained a low turnover rate.
Comments:
6. Contractor met scheduled contract delivery dates.
Comments:
7. Contractor provided accurate, complete and high-quality deliverables.
Comments:
8. Contractor complied with the terms of the contract.
Comments:
9. Contractor was diligent in forecasting and controlling contract cost.
Comments:
10. I would recommend award to this contractor again.
Comments:
| 1 |
| 0 – 25% of the time |
| Strongly Disagree |
| PLEASE RETURN COMPLETED RESPONSE TO: Melva Stennis |
E-MAIL: melva.stennis@va.gov Deadline: No Later Than 6/15/2023
| 2 |
| 26 – 40% of the time |
| Disagree |
| 3 |
| 41 – 55% of the time |
| Somewhat Disagree |
| 4 |
| 56 – 70% of the time |
| Somewhat Agree |
| 5 |
| 71 – 85% of the time |
| Agree |
| 6 |
| 86 – 100% of the time |
| Strongly Agree |
NA
No Knowledge of This Element
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