Past Performance Questionnaire.pdf

VA PROGRAM CONTRACTING ACTIVITY CENTRAL ● 6100 OAK TREE BLVD SUITE 490 ● INDEPENDENCE, OH 44131

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

*All PPQs are included in the 50-page limit for SF330 submissions.

SECTION 1

CONTRACT INFORMATION – Contractor to complete #1-3

1. CONTRACTOR INFORMATION

NAME OF OFFEROR BEING EVALUATED: Click or tap here to enter text.

ADDRESS: Click or tap here to enter text.

POINT OF CONTACT: Click or tap here to enter text.

CONTACT PHONE NUMBER: Click or tap here to enter text.

CONTACT EMAIL ADDRESS: Click or tap here to enter text.

WORK PERFOMED AS: Click or tap here to enter text.

PERCENT OF PROJECT WORK PERFORMED: Click or tap here to enter text.

IF SUBCONTRACTOR, WHO WAS THE PRIME? Click or tap here to enter text.

2. CONTRACT INFORMATION

CONTRACT TITLE: Click or tap here to enter text.

CONTRACT NUMBER AND DO/TO NUMBER: Click or tap here to enter text.

CONTRACT TYPE: Choose an item.

if other:

CONTRACT LOCATION: Click or tap here to enter text.

AWARD DATE: Click or tap to enter a date.

ORIGINAL CONTRACT ACCCEPTANCE (construction accepted) Date: Click or tap to enter a date.

ACTUAL CONTRACT ACCEPTANCE: Click or tap to enter a date.

EXPLAIN DIFFERENCES: Click or tap here to enter text.

ORIGINAL IMPLEMENTATION PRICE: Click or tap here to enter text.

ORIGINAL CONTRACT PRICE (all costs - design/installation/financing): Click or tap here to enter text.

FINAL CONTRACT PRICE (including modifications, if applicable): Click or tap here to enter text.

EXPLAIN DIFFERENCES: Click or tap here to enter text.

3. PROJECT DESCRIPTION

SCOPE INCLUDED IN PROJECT: Click or tap here to enter text.

HOW IS THIS PROJECT RELEVANT TO PROJECT OF SUBMISSION? Click or tap here to enter text.

SECTION 2

EVALUATOR INFORMATION – Client to complete

Veterans Health Administration (VHA) Program Contracting Activity Central (PCAC) is considering the Offeror identified above for award of the Project # 520-332 Expand Behavioral Health, Lab, and Imaging at Eglin Air Force Base, VA Clinic, Eglin Air Force Base, Florida , 32542– 36C7762R0036.

Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the company’s ability to perform the work as described in the solicitation. Please verify the accuracy of the information in Section 1 and complete the questionnaire as thoroughly as possible. VHA-PCAC may contact you in order to obtain any additional information regarding a contract award.

Please return your completed questionnaire to the Offeror to be incorporated into the SF330 submission. PPQs should NOT be submitted directly to VHA PCAC by the client. Refer to the solicitation for SF330 submission due date.

EVALUATOR INFORMATION

NAME OF EVALUATOR: Click or tap here to enter text.

POSITION: Click or tap here to enter text.

ADDRESS: Click or tap here to enter text.

PHONE: Click or tap here to enter text.

EMAIL: Click or tap here to enter text.

DESCRIBE YOUR ROLE IN THE PROJECT: Click or tap here to enter text.

*Please see Page 4 for Adjectival Ratings for the following:

1. QUALITY

Ability to meet quality design and/or construction standards specified for technical performance Choose an item.

Comments:

2. SCHEDULE/ TIMELINESS OF PERFORMANCE

Compliance with contract delivery/completion schedules including timely submission of data deliverables (If liquidated damages were assessed or the schedule was not met, please address below.)

Choose an item.

Comments:

3. COMMUNICATION

Contractor was reasonable and cooperative in dealing with client staff (including the ability to successfully resolve disagreements/disputes and responsiveness to client requests)

Choose an item.

Comments:

4. MANAGEMENT/ PERSONNEL/ LABOR

Effectiveness of management, including suppliers, materials, and/or labor force (including the ability to effectively lead, manage, and control the project) Choose an item.

Continuity in the contractor’s personnel during execution of the contract (e.g., one person or team that stayed with the project throughout the contract) Choose an item.

Comments:

5. COST/ FINANCIAL MANGEMENT

Ability to meet the terms and conditions within the contractually agreed price Choose an item.

Comments:

6. SUBCONTRACT MANAGEMENT

Ability to manage subcontracting effort, including any subcontracting issues, and the contractor’s ability to resolve the problems without extensive customer guidance

Choose an item.

Comments:

7. SUMMARY

Would you hire or work with this firm again? If no, please explain below. Choose an item.

Provide an overall rating for the work performed by this contractor. Choose an item.

ADDITIONAL COMMENTS:

EVALUATOR SIGNATURE: DATE:

ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE

*THIS PAGE WILL BE REMOVED FOR EVALUATION PURPOSES AND NOT BE COUNTED

TOWARD THE SF330 PAGE COUNT – IT IS FOR PPQ COMPLETION PURPOSES ONLY*

Adjectival Description

Outstanding Indicates an exceptional approach and understanding of the requirements. The response contains multiple strengths and no deficiencies.

Good Indicates a thorough approach and understanding of the requirements. Response contains at least one strength and no deficiencies.

Acceptable

Indicates an adequate approach and understanding of the requirements. Response has no strengths that exceed specified performance or capability requirements and has no significant deficiencies.

Marginal Does not clearly meet requirements and has not demonstrated an adequate approach and understanding of the requirements.

Unacceptable Does not meet requirements and contains one or more deficiencies. Response is not awardable.

Neutral

(Applies only to Past Performance)

Offeror’s performance record, relevant past performance or information on past performance is not available