Past Performance Questionnaire.pdf

Procurement Sensitive Do not Disclose----See FAR Subparts 2.101 and 3.104-4

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

Source Selection Information-See FAR 2.101 & 3.104

ATTACHMENT 2: PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire to Replace Security Camera Surveillance System for the Memphis Veteran Affairs Medical Center (VAMC).

PAST PERFORMANCE INSTRUCTIONS

The NCO 9 Network Contracting Office has issued a solicitation to Replace Security Camera Surveillance System.

Past performance information will be used to evaluate proposals received. Section A is to be completed by the Offeror. Section A of the enclosed questionnaire lists the contractor who has identified your office as a source to evaluate their past performance. Section A also authorizes release of this information to NCO 9 Network Contracting Office.

The Offeror must provide this entire document to each of its assessors. The Assessor shall only submit past performance questionnaires directly to the Contracting Officer-Scheronica Cochran by way of email at scheronica.cochran@va.gov.

Section B in its entirety is to be completed by the assessor(s). An individual assessor knowledgeable of the contractor’s quality of supplies and services rendered is requested to verify, complete the questionnaire, and submit to the Contracting Office. If evaluating more than one contract for the same contractor, use a separate questionnaire for each contract being evaluated.

Because this information is critical to the evaluation process, your time and effort in providing your assessment is greatly appreciated. The questionnaire should be completed as soon as possible but not later than July 13, 2020 12:00pm Central Time. Assessor is requested to send electronically to Scheronica Cochran (scheronica.cochran@va.gov). Assessor: Please do not send this information to the Offeror being evaluated.

Thank you in advance for your cooperation and expeditious response to this request.

VHATVHCOCHRS

Highlight

FOR OFFICIAL USE ONLY

Source Selection Information-See FAR 2.101 & 3.104

Procurement Sensitive Do not Disclose----See FAR Subparts 2.101 and 3.104-4

FOR OFFICIAL USE ONLY

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 36C24920R0074 Project/Requirement Replace Security Camera Surveillance System Customer/Agency Department of the Veteran Affairs, NCO 9, Murfreesboro, TN 37129

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 Office, Murfreesboro, Tennessee (Signature)

(Name and Title of Authorizing Official) (Date)

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