Past Performance Questionnaire.docx

DOCX document 15 KB Posted

Attached to
6505--Radiopharm (Questions & Answers) Federal contract opportunity
Solicitation number
36C24823Q0132
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

About this file

This document includes a past performance questionnaire and details of a federal contract opportunity for radiopharmaceuticals. The opportunity was issued by the Network Contracting Office 8 of the West Palm Beach Veteran Affairs Medical Center on behalf of Veterans Integrated Service Network 8. It seeks fixed price IDIQ contracts for radiopharmaceutical products under NAICS code 325412 with a size standard of 750 employees. Interested parties should monitor FBO for additional information and submit offers by the specified deadline. The past performance questionnaire is intended to collect performance ratings and data on previous relevant contracts from references for evaluation.

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Text version

PAST PERFORMANCE QUESTIONNAIRE

Name of offeror: ___________________________________

Contract Information:

Name of Contractor: _________________________________ Contract Number: ___________________________

Contract Title: ________________________________________________________________________________

Type of Contract: ____________________________________ Period of Performance: ______________________

The ratings indicated below are to be supplied by the reference and not the offeror)

Performance Elements
Satisfactory
Unsatisfactory

1. Technical (Quality of Product or Service) (evaluation of the contractor’s technical performance or progress toward meeting requirements)

2. Schedule (evaluation of the timeliness of the contractor against milestones, delivery schedules)

3. Cost Control (evaluation of the contractor’s effectiveness in forecasting, managing, controlling cost and submitting accurate invoices)

4. Business Relations (assess the integration and coordination of all activity needed to execute the work, specifically the timeliness, completeness and quality of problem identification, corrective action, the contractor’s history of reasonable and cooperative behavior, customer satisfaction)

5. Management of Key Personnel (assess the contractor’s personnel performing the work)

6. Overall Rating

Remarks on unsatisfactory performance (Provide data supporting this observation. You may continue on separate sheet if needed.)

Would you do business with the offeror again? ________________________________________________________

Information provided by:

Name of Source: ___________________________________________________ Title: ____________________________________________________________ Mailing Address: ___________________________________________________ City, State and Zip Code: ____________________________________________ Telephone Number: ________________________________________________ Date: ____________________________________________________________

Questionnaire completed by:

Name of VA Employee: ____________________________________________ Title: ___________________________________________________________ Date: ___________________________________________________________ Signature: _______________________________________________________

File details come from the government source that posted it. Updated .