Past Performance Questionnaire.docx

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Attached to
3650--763-26-2-228-0242 -Lancaster CMOP Low to Medium Volume TCA and Sorting Loops Project (VA-26-00039446)
Solicitation number
36C77026R0007
Issued by

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This is a Past Performance Questionnaire template designed for prime contractors to solicit reference information from previous clients regarding their performance on past contracts.

The questionnaire is associated with Solicitation Number 36C77026R0007 for Low to Medium Volume TCA and Sorting Loops services at the Dallas (Lancaster) Consolidated Mail Outpatient Pharmacy (CMOP) operated by the Department of Veterans Affairs. Prime contractors are instructed to complete the contractor information section and distribute the form to reference contacts who evaluate past performance across 21 assessment criteria using a 0-5 scale, with 0 representing neutral/no record and 5 representing exceptional performance. The evaluation criteria address key competency areas including management experience and personnel staffing capabilities (items 1-5), technical performance in automation systems including throughput, accuracy, and reject rates (item 6), system integration with existing pharmacy and enterprise systems (item 7), phased installation and cutover execution (item 8), cybersecurity and data integrity management (item 9), deficiency correction and problem resolution procedures (items 10-14), onboarding and background investigation processes (item 15), responsiveness to contract changes (item 16), staffing consistency (item 17), cooperation with government personnel (item 18), and contract compliance history including cure notices and contractor recommendation for future awards (items 19-20). Reference contacts must provide an overall performance rating and detailed remarks explaining ratings, particularly regarding automation performance, schedule adherence, and system reliability. Completed forms should be returned to Kelley Cunningham at Kelley.Cunningham@va.gov.

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File Type Posted
36C77026R0007_2.docx DOCX document
PWS TCA System Installation_Final.docx DOCX document
BUSINESS ASSOCIATE AGREEMENT.pdf PDF
Attachment 1 for Dallas CMOP TCA Low to Medium Volume.docx DOCX document

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Past Performance INSTRUCTIONS TO PRIME CONTRACTOR: (Contractor submitting proposal):

Complete the CONTRACTOR INFORMATION section. Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.

Company Name

Street Address

Point of Contact

City

Point of Contact Phone Number

State

E-Mail Address

Zip Code

Solicitation Number
36C77026R0007
Description of Work
Low to Medium Volume TCA and Sorting Loops for Dallas (Lancaster) CMOP

INSTRUCTIONS TO REFERENCE CONTACT

Please complete the following pages as a past performance Reference Contract for the entity named above. Once completed, please return the form to: Kelley Cunningham, Kelley.Cunningham@va.gov.

RESPONDENT INFORMATION [completed by Reference Contact]

Government Agency or Company name

Street Address

POC Name

City

Phone Number

State

Fax Number

Zip Code

Email

Contract Number

Prime or Subcontractor

Dollar Value

Period of Performance

Description of services provided

Location of services provided

Number of FTEE YOUR FIRM provided

PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below (text box will expand to whatever extent is necessary).

0
1
2
3
4
5
NEUTRAL
UNSATISFACTORY
MARGINAL
SATISFACTORY
GOOD
EXCEPTIONAL
No record of past performance or the record is incon-clusive.
Performance did not meet most contractual require-ments. There were serious problems and the contractor’s corrective actions were ineffective.
Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.
Performance met most contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.
Performance met all contract requirements and exceeded some. There were a few minor problems, which the contractor resolved in a timely, effective manner.
Performance exceeded all contract requirements. There were no problems.
The Contractor …
0
1
2
3
4
5
1.
Provided experienced managers and/or supervisors with the technical and administrative abilities needed to meet contract requirements.
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2.
Demonstrated ability to hire, maintain, and replace, if necessary, sufficient qualified personnel throughout the contract period.
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3.
Ability to fill staff vacancy in a timely manner.
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4.
Home office participated in solving significant local problems as necessary.
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5.
Had sufficient personnel to monitor, support and provide oversight for large numbers of staff at geographically dispersed locations.
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6.
Met technical performance requirements (throughput, accuracy, and reject rates) for automated systems.
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7.
Successfully integrated automation with existing host systems (e.g., pharmacy operating systems, databases, or similar enterprise systems) with minimal disruption.
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8.
Planned and executed phased installation and cutover without unacceptable impact to ongoing operations.
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9.
Effectively managed cybersecurity, data integrity, and audit‑trail requirements as part of system deployment and operation
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10.
Corrected deficiencies in timely manner and pursuant to their quality control procedures.
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11.
Provided timely resolution of contract discrepancies
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12.
Identified problems as they occurred.
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Suggested alternative approaches to problems.
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14.
Displayed initiative to solve problems.
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15.
Managed on-boarding and background investigation process efficiently and timely.
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16.
Was responsive to contract changes.
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17.
Maintained consistent staffing levels for positions in cases of call outs, illnesses, injuries, etc.
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18.
Cooperated with Company/ Government personnel after award.
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19.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
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YES
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NO
20.
Would you award another contract to this contractor? If not, please explain in “remarks.”
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YES
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NO
21.
OVERALL PERFORMANCE RATING:
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REMARKS (Please use as much space as is needed – the box will expand as you type. Please describe any notable strengths or weaknesses related to automation performance (throughput, reject rates, integration), schedule adherence, and system reliablility).

I hereby certify that the information that I have reported above is accurate to the best of my knowledge.

Printed Name

E-mail address

Business Title

Signature

Date

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