Past Performance Questionnaire.docx
DOCX document 19 KB Posted
- Attached to
- Cremation and Burial Services
- Solicitation number
- 36C25926Q0820
About this file
This is a Past Performance Questionnaire template designed for contractors to provide detailed information about their experience performing similar services under previous federal contracts. The questionnaire requires contractors to document key contract details including the contractor name, comprehensive description of services performed, performance dates, total contract value, organization and point of contact information, and contract/task order numbers. Contractors must also indicate whether they served as a prime contractor and rate the complexity of work as high, medium, or low.
The questionnaire includes a performance rating section requiring contractors to rate their overall performance against three standardized criteria: Outstanding (exceeded expectations and accomplished unanticipated goals), Satisfactory (met expectations and requirements), or Unsatisfactory (did not meet expectations). If rated anything other than Satisfactory, contractors must provide detailed justification, examples of strengths, and areas for improvement. The completed questionnaire must be signed by an authorized representative and submitted to the contracting officer or designated point of contact by the quote deadline, with a verification statement certifying the accuracy and completeness of the information provided. This questionnaire appears to support the Department of Veterans Affairs Salt Lake City Health Care System's four-year Blanket Purchase Agreement solicitation (36C25926Q0820) for mortuary and cremation services for deceased unclaimed or indigent Veterans in Utah.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| WD 15-5483 Rev 31.pdf | ||
| WD 15-5491 Rev 30.pdf | ||
| WD 15-5493 Rev 30.pdf | ||
| S02 36C25926Q0820.docx | DOCX document | |
| Performance Work Statement.docx | DOCX document | |
| SURVEILLANCE CHECKLIST.docx | DOCX document | |
| WD 15-5489 Rev 31.pdf | ||
| WD 15-5501 Rev 32.pdf | ||
| RFQ Cremation and Burial Services.docx | DOCX document | |
| BPA Terms.docx | DOCX document | |
| QASP.docx | DOCX document | |
| VHA Directive 1601B_04_2017-12-01.pdf | ||
| WD 15-5485 Rev 31.pdf | ||
| WD 15-5487 Rev 31.pdf | ||
| WD 15-5495 Rev 30.pdf | ||
| WD 15-6037 Rev 6.pdf | ||
| VA Handbook 6500_6_March_12_2010.pdf | ||
| SERVICES SUMMARY TABLE.docx | DOCX document | |
| WD 15-5497 Rev 30.pdf |
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Text version
Past Performance Questionnaire Instructions:
1. Complete all sections of the questionnaire.
2. Ensure all contact information is accurate and up-to-date.
3. Have the contractor send a signed and completed questionnaire to the contracting officer or designated point of contact by the quote deadline.
1. Name of contractor being reviewed:
2. Description of Services Performed:
· Please provide a detailed description of the services performed under this contract. Include any specific objectives, scope of work, and notable achievements or challenges encountered.
· Prime contractor? Yes or no
· Complexity: ☐ HIGH ☐MEDIUM ☐LOW
3. Performance Dates:
· Start Date (MM/DD/YYYY):
· End Date (MM/DD/YYYY):
4. Total Contract Value:
· Please provide the total value of the contract (in USD):
5. Addresses:
Organization Name:
Street Address:
City:
State:
ZIP Code:
6. Contract Numbers:
· Contract Number:
· Task Order Number (if applicable):
7. Point of Contact Information:
· Name:
· Title:
· Phone Number:
· Email Address:
8. Performance Rating:
· Please rate the overall performance of the contractor according to the following criteria:
· Outstanding: Performance significantly exceeded expectations in all essential areas and accomplished goals that were not anticipated.
· Satisfactory: Performance met expectations and contract requirements.
· Unsatisfactory: Performance did not meet expectations and contract requirements.
· Please check the appropriate rating:
· ☐ Outstanding
· ☐ Satisfactory
· ☐ Unsatisfactory
· Additional Comments (if rated other than satisfactory): Lengthy explanation or justification for the given rating, including examples of the contractor's strengths or areas for improvement:
Verification:
· The information provided above is accurate and complete to the best of my knowledge. I authorize the verification of the services performed as described.
Signature: Please sign as indicated below Name:_________________________ Title:___________________________ Date:__________________________
File details come from the government source that posted it. Updated .