Past Performance Questionnaire.docx
DOCX document 16 KB Posted
- Attached to
- Q511--VISN 10 IN & MI Optical Dispensing Service
- Solicitation number
- 36C25026R0012
About this file
This is a Past Performance Questionnaire designed to evaluate contractor performance on the VISN 10 IN & MI Optical Dispensing Service contract (Solicitation No. 36C25026R0012) issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The questionnaire is a template for obtaining feedback from government officials or end users regarding a contractor's past performance and ability to perform similar future work.
The questionnaire uses an eight-question format with a five-point rating scale (1 = unacceptable, 5 = superior performance, with N/A option) to assess contractor performance across key competency areas including: work quality and skillfulness, personnel qualifications and equipment provision, reasonableness and cooperation, timely and complete paperwork submission, cost control and budget adherence, compliance with laws and regulations, overall work quality, and likelihood of future contract award. Respondents are requested to provide detailed comments and submit completed questionnaires to Kristina L. Peart, Contracting Officer, at Kristina.Peart@va.gov. The form requires respondent identification including name, company/agency, address, phone number, title, and signature date.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25026R0012 0001.docx | DOCX document | |
| IN and MI Historical Trends Dispensary.xlsx | XLSX spreadsheet | |
| 36C25026R0012.docx | DOCX document |
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Text version
Please complete this questionnaire in regard to the contractor or contract identified below:
| CONTRACTOR: | ___________________________________________ |
| ___________________________________________ | |
| ___________________________________________ |
RE: SOLICITATION NO. 36C25026R0012
NATURE OF WORK: VISN 10 IN & MI Optical Dispensing Service
RETURN TO: Kristina L. Peart, Contracting Officer, Kristina.Peart@va.gov
For the following questions, choose the number on the scale from 1 to 5, which most accurately describes the Contractor’s performance on the contract listed above. A “5” represents superior performance while a “1” represents unacceptable performance. If the question is not applicable, circle “N/A”. Please add any comments and information that may help to determine the Contractor’s probable performance.
1. Was the contractor’s work was performed in a skillful and 1 2 3 4 5 N/A Good workmanship like manner?
| 2. | Did the contractor provide qualified personnel necessary | 1 2 3 4 5 N/A |
| equipment and quality control for performance? |
3. Was the contractor reasonable and cooperative during 1 2 3 4 5 N/A and after contract performance?
4 Did the contractor submit paperwork timely and completely? 1 2 3 4 5 N/A
| 5. | Did the contractor consistently and adequately control | 1 2 3 4 5 N/A |
| Cost and did they adhere to their initial budget? |
| 6. | Did the contractor comply with laws, regulations, and | 1 2 3 4 5 N/A |
| facility rules? |
| 7. | Evaluate the Contractor’s overall quality of work under | 1 2 3 4 5 N/A |
| the contract. |
| 8. | Would you award similar contracts to the Contractor | 1 2 3 4 5 N/A |
| in the future? |
Past Performance Questionnaire
COMMENTS:
Thank you for your assistance.
NAME:
COMPANY/AGENCY:
ADDRESS:
PHONE:
SIGNATURE:
TITLE: _______
DATE:
PLEASE RETURN TO: Kristina L. Peart at Kristina.Peart@va.gov
File details come from the government source that posted it. Updated .