PAST PERFORMANCE QUESTIONNAIRE.docx

PAST PERFORMANCE QUESTIONNAIRE

RFP NUMBER:

TITLE:

OFFER / QUESTIONNAIRE DUE DATE:

SECTION I: OFFERORS: COMPLETE requested information (Section I) and PROVIDE the questionnaire to the appropriate Respondent for each source of Past Performance Information mentioned in your Offer. The Respondent must have significant familiarity with the selected contract or subcontract to provide informed answers and comments about various aspects of the past performance.

NAME OF OFFEROR:

NAME OF PAST PERFORMANCE REFERENCE:

CONTRACT NUMBER & DATES OF SERVICE:

DESCRIPTION OF SERVICE:

TOTAL AWARD PRICE:

SECTION II: RESPONDENT(S): COMPLETE the requested information (Section II) concerning the past performance of the above named Offeror relative to the referenced contract effort. To select the applicable response, double-click the box and select “Checked” for Default value.

NAME OF RESPONDENT:

TITLE/POSITION:

SIGNATURE:

(A) QUALITY OF SERVICE

1. Did the contractor comply with all contract requirements? |_| Yes |_| No

Comments:

2. Regarding timeliness of performance, were turnaround times of the contract met (i.e. completion of administrative requirements, task orders, milestones, production, and delivery requirements?) |_| Yes |_| No

Comments:

3. Was the contractor's work found to be accurate and technically/clinically sound?

|_| Yes |_| No Comments:

4. How would you rate the quality of the contractor's end products / services furnished under this contract? |_| Outstanding |_| Good |_| Acceptable |_| Unacceptable

Comments:

5. How would you rate the quality of the contractor's customer service furnished under this contract? |_| Outstanding |_| Good |_| Acceptable |_| Unacceptable

Comments:

(B) BUSINESS RELATIONS

5. Was contract Management efficient and responsive?

|_| Always |_| Most of the time |_| Sometimes |_| Never

6. Did the contractor exhibit effective communication(s)?

|_| Always |_| Most of the time |_| Sometimes |_| Never

7. Did the contractor exhibit reasonable and cooperative behavior?

|_| Always |_| Most of the time |_| Sometimes |_| Never

8. Was the contractor flexible?

|_| Always |_| Most of the time |_| Sometimes |_| Never

9. Did the contractor recommend effective solutions to problems?

|_| Always |_| Most of the time |_| Sometimes |_| Never

10. Did the contractor exhibit a business-like concern for the interests of your Agency or Business:

|_| Always |_| Most of the time |_| Sometimes |_| Never

11. How would you rate the contractor in the area of business relations generally?

|_| Outstanding |_| Good |_| Acceptable |_| Unacceptable

Comments on questions 6 through 11 above:

(C) CUSTOMER SATISFACTION

12. How would you rate the contractor based on customer (end-user) satisfaction?

|_| Outstanding |_| Good |_| Acceptable |_| Unacceptable

13. Would you select this firm again? |_| Yes |_| No

Comments:

End of Section II

SECTION III: COMPLETED FORM MUST BE RETURNED TO THE VA CONTRACTING OFFICE PRIOR TO THE DUE DATE FOR RECEIPT OF PROPOSALS. THE OFFEROR MAY SUBMIT THE COMPLETED QUESTIONNAIRE ALONG WITH HIS/HER PROPOSAL; OR, THE RESPONDENT PROVIDING THE PERFORMANCE INFORMATION HEREIN MAY FORWARD THE COMPLETED FORM DIRECTLY TO THE CONTRACTING OFFICE, IF PREFERRED.

IN ALL CASES, THE COMPLETED PAST PERFORMANCE REFERENCES MUST REACH THE CONTRACTING OFFICE BY THE DATE AND TIME OFFERS ARE DUE. THE GOVERNMENT BEARS NO RESPONSIBILITY TO ASSURE QUESTIONNAIRES ARE PROPERLY RECEIVED.

POC: Andres Cepeda Contracting Officer

NCO 02

Lyons, NJ Phone: (908) 647-0180 x4457 Email (preferred): andres.cepeda@va.gov