Past Performance Questionnaire Attachment.docx
DOCX document 20 KB Posted
- Solicitation number
- 36C10D26Q0170
- Issued by
-
Department of Veterans Affairs
About this file
This is a Past Performance Questionnaire template for Solicitation 36C10D26Q0170 issued by the Department of Veterans Affairs. The document is designed to collect reference information from previous customers or contracting officers regarding a contractor's performance history on prior contracts and efforts. Completed questionnaires must be returned no later than August 4, 2026 at 1:00 pm EST to Tracey.Robinson3@va.gov. The form requests that references be submitted directly to the VA evaluator and not returned to the contractor originating the request.
The questionnaire evaluates contractors across three primary assessment areas: quality and meeting contract requirements (including customer satisfaction and instances of rework or deficiency reports); quality and timeliness of delivery (addressing schedule adherence, causes of variances, and timely submission of information and invoices); and additional observations regarding overall contractor performance and likelihood of future engagement. The template includes fields for capturing contractor information, the reference contact's organizational details, and narrative responses that may be expanded with additional attachments if needed.
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| 36C10D26Q0170.docx | DOCX document |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Solicitation 36C10D26Q0170
The individual providing the reference shall complete and return NLT 8/4/26 1:00 pm EST to:
Email: Tracey.Robinson3@va.gov
On behalf of (Requester/Contractor Information):
| Company's Name: | __________________ | |
| POC/Title/Position: | __________________ | |
| Email Address: | __________________ | |
| Contract/Purchase Order No.: | __________________ | |
| Contract Amount: | __________________ | |
| Period of Performance: | __________________ | |
| Business Address: | __________________ | |
| __________________ |
Phone Number: __________________
NOTE: DO NOT RETURN TO THE CONTRACTOR WHO ORIGINATED THIS REQUEST
The completion of this questionnaire is requested from your agency/company in order for the Department of Veterans Affairs to evaluate the aforementioned contractor’s past performance on previous contracts and efforts as it relates to the probability of successful accomplishment of the work required by the Government, relative to the award of a contract.
Completed by :
| Federal Agency/Company’s Name: | _________________________________ | ||
| POC/Title/Position: | _________________________________ | ||
| Email Address: | _________________________________ | ||
| Address: | _________________________________ | ||
| _________________________________ | |||
| _________________________________ | |||
| Phone Number: | _________________________________ |
1. Quality/Meeting Contract Requirements: The offeror’s demonstrated history of delivering products and services that met or exceeded the requirements of the contract.
a. How would you describe your level of customer satisfaction?
b. Were there instances of rework and/or deficiency reports? (If yes, explain)
2. Quality/Timeliness.
a. Describe the contractor’s ability to deliver according to the agreed-to schedule. What were the causes of any schedule variances?
b. Describe the timeliness of submission of requested information, reports and invoicing.
3. Additional Observations/Information
a. Given hindsight, are you satisfied that the contract was awarded to this contractor? Would you be pleased to have this contractor perform work for you again? Why?
(If more comment space needed, please attach additional pages.)
File details come from the government source that posted it. Updated .