Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to assessors)

Solicitation Number 36C24920R0049 Project/Requirement 626-18-202/Upgrade Surgical Suite Air Handling Units Customer/Agency Department of the Veteran Affairs, NCO 9, TVHS

1. Prospective Government Contractor’s

Name and Address:

2. Contractor Point of Contact:

3. Phone number (with area code):

4. Assessor Contract Award number:

5. Description of Services provided under contract:

6. Contract award date: Contract Amount: Initial Final

7. Period of Performance or Delivery Date:

ASSESSOR INFORMATION:

Assessor Name Title Phone Number/Email Address

8. Authorization is hereby granted to provide the information requested in this questionnaire to NCO 9 Network Contracting Activity, Murfreesboro, Tennessee

(Signature)

(Name and Title of Authorizing Official) (Date)

SECTION B: Assessors Information (to be completed by assessors.

RATING SCALE Definitions

Past Performance Evaluation Ratings Rating Description ACCEPTABLE Based on the offeror’s performance record, the

Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

UNACCEPTABLE Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.

QUALITY OF SERVICE

1. Rate the contractor’s compliance with contractual requirements.

ACCEPTABLE UNACCEPTABLE

2. Overall rating of contractor quality of service.

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

SCHEDULE

3. Delivery of service was within required time period specified by contract requirements.

4. Rate the contractor’s ability to control cost and submit invoices.

Are invoices complete, accurate, and timely?

BUSINESS RELATIONS

5. Overall rating of contractor’s business practices (e.g. maintaining

A positive working relationship, business ethics, timely and effectively Resolution of any problems, etc.)

6. Rate the working relationship between contractor’s management, and your company (i.e. contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer).

7. Rate the contractor's ability to submit required reports and/or invoices in a timely manner.

8. Rate the contractor’s responsiveness to customer complaint resolution.

9. Overall rating of contractor’s business relations.

How would you feel about awarding another contract to this contractor?

Would not hesitate to award another contract to this contractor.

Would most likely award another contract to this contractor.

Would think twice about awarding another contract to this contractor, but would do so if no better alternative existed.

Do not wish to award another contract to this contractor.

Would not award another contract to this contractor.

Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.

VII. General Comments:

ASSESSOR:

Identify your role in the contract award or administration and the period of your involvement.

Role Period of Involvement Contract Specialist/Contracting Officer

Technical Project Lead/Project Officer

OTHERS

(Signature) (Date)

(Typed or Printed Name) (Organization Name)

(Phone Number)

VII. General Comments: