Past Performance Questionnaire.docx

This is a Past Performance Questionnaire template for evaluating contractor performance on federal contracts. The questionnaire is issued by the Department of Veterans Affairs for solicitation 36C26127Q0039 ("Furniture Moves, Installation and Storage") and is designed to collect reference information from past clients regarding a company's performance on previous contracts. Evaluators are instructed to complete a separate survey for each reference and submit the signed questionnaire to jill.williams@va.gov. The form requests evaluator identification, company information, and details regarding contracts previously performed, including total contract amounts, performance dates, and contract numbers. Evaluators are asked to rate overall work quality on a scale of Excellent, Good, Fair, Marginal, or Unacceptable, with space for supporting comments. The questionnaire also inquires about any performance issues or concerns encountered and how those concerns were addressed.

This questionnaire supports a VA solicitation for Furniture Moving, Installation and Storage Services for the Veterans Integrated Service Network 21 (VISN 21) in accordance with a Performance Work Statement. The solicitation is a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside, requiring all offerors to be verified SDVOSB at time of quote submission and to maintain that status through award, performance, and final payment. Offerors must submit a completed VAAR Clause 852.219-75 or face exclusion from evaluation and ineligibility for award. The solicitation closed on October 6, 2026 at 11:00am PST.