Past Performance Questionnaire.docx

This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate contractor performance for the Workers Compensation Recovery Assistance contract (Solicitation ID: 36C26126Q0379). The questionnaire is designed to collect reference information from past clients of companies bidding on this VA contract, with completed surveys required as part of the proposal submission to the Veterans Health Administration Veterans Integrated Service Network 21.

The questionnaire requires offerors to submit a separate survey for each reference, with evaluator responses directed to jill.williams@va.gov. Evaluators must identify the company being assessed, provide their name, signature, company affiliation, and contact information, then detail any previous contracts performed including total contract amounts, performance dates, and contract numbers. Evaluators are asked to rate the overall quality of work on a scale of Excellent, Good, Fair, Marginal, or Unacceptable with supporting comments, and to identify any performance issues or concerns and how they were resolved. The template notes that evaluator identities will remain confidential and not be released publicly.