Past Performance Questionnaire.docx
DOCX document 21 KB Posted
- Solicitation number
- 36C24426Q0953
About this file
This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate contractor performance on previous similar contracts. The questionnaire is distributed to past clients or contracting entities who have worked with an offeror proposing to provide Veteran Taxi Services, specifically for the Coatesville VAMC Veteran Ride Share Transportation Service solicitation (36C24426Q0953).
The questionnaire requests references to assess performance across three primary categories: quality of performance (including conformance to contract specifications, standards of workmanship, timely deliveries, and quality of products delivered); management performance (including management responsiveness, program coordination and resource management, and conflict resolution); and general comments. Respondents rate performance using a three-point scale: Satisfactory (performance meets contractual requirements with minor issues and effective corrective actions), Unsatisfactory (performance fails to meet requirements with significant problems and ineffective corrective actions), or Not Applicable (unable to provide meaningful assessment). The questionnaire requests reference information including company name, contact person, government contract number, period of performance dates, and scope of services details. Completed questionnaires are to be returned to Victoria.Droz@va.gov. All information provided is classified as Source Selection Information and is exempt from FOIA disclosure.
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Other files
| File | Type | Posted |
|---|---|---|
| Delaware County WD 2015-4233_Rev 38_08-22-2026 .pdf | ||
| Lancaster County WD 2015-4229_Rev 34_08-12-2026.pdf | ||
| 36C24426Q0953 0003.docx | DOCX document | |
| 36C24426Q0953 0002.docx | DOCX document | |
| 36C24426Q0953 0001.docx | DOCX document | |
| 36C24426Q0953.pdf | ||
| Local BAA Template.doc | DOC document | |
| WD 2015-5791 Chester County.pdf | ||
| 6500 Append D Rules of Behavior_2024.pdf |
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Text version
Past Performance Questionnaire The Department of Veterans Affairs is evaluating a proposal submitted by _________________________ [Offeror’s name], hereafter referred to as “Offeror,” to provide Veteran Taxi Services. Offeror has provided this questionnaire to you so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.
Any information you provide in this questionnaire is considered Source Selection Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release the your name or the names of other individuals providing reference information about Offeror’s past performance.
Instructions: Be honest. Provide an assessment of Offeror’s past performance by checking the box of one the following rating options. You are encouraged to write comments as often as you’d like.
Rating Options:
Satisfactory—Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.
Unsatisfactory—Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.
Not Applicable—Unable to provide a meaningful assessment.
When you are finished, please email your completed questionnaire to: Victoria.Droz@va.gov
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Performance Assessment
1. Reference Information Company Name: _______________________________________________________________________ Your Name: ___________________________________________________________________________ Contract Number (if Government): ________________________________________________________ Period of Performance: Start Date:_______________________ End Date:________________________ Scope of Services (e.g., contract dollar value, geographic coverage area, frequency of services, etc.):
2. Quality of performance Assess Offeror’s quality of performance in these areas:
| Satisfactory |
| Unsatisfactory |
| N/A |
Conformance to contract specifications
Standards of workmanship (technical, professional, safety, and the like)
Timely deliveries
Quality of products delivered (Was the right product delivered in the proper condition)
3. Management performance Assess Offeror’s contract management performance in these areas:
| Satisfactory |
| Unsatisfactory |
| N/A |
Management responsiveness (timeliness, reliability, cooperation, etc.)
Management of program (coordination, use of resources, communication, risk management, etc.)
Management of conflicts or issues (reactive, provides good solutions, flexible to changing needs, etc.)
4. General comments
Assessor’s Signature:_____________________________________ Date:_____________________
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Source Selection Information—See FAR 2.101 and 3.104
File details come from the government source that posted it. Updated .