Past Performance Questionnaire.docx

This is a Past Performance Questionnaire template designed for the Department of Veterans Affairs to evaluate contractor performance on the Special Needs Ground Transportation contract (Solicitation ID: 36C26126Q0450). The questionnaire is administered to references provided by offerors and completed separately for each reference to assess the contractor's past performance capabilities relevant to this VA contract opportunity.

The questionnaire requires evaluators to provide company information, identify specific contracts performed, contract amounts, performance dates, and contract numbers. Evaluators must rate the overall quality of work on a scale of Excellent, Good, Fair, Marginal, or Unacceptable, with supporting comments encouraged. The form also solicits information regarding any performance issues or concerns and how such issues were resolved. Completed surveys must be signed and emailed to jill.williams@va.gov. The VA emphasizes that evaluator identities and reference information provided will remain confidential and not be released publicly. This questionnaire serves as a key evaluation component for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21, which is soliciting quotes for Special Needs Ground Transportation services from Service-Disabled Veteran-Owned Small Business (SDVOSB) vendors, with quotes due by 11:00 AM on March 27, 2026.