Past Performance Questionnaire.pdf

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Attached to
Bend, OR VA Janitorial Services for Clinic
Solicitation number
36C26025Q0560
Issued by

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The document is a Past Performance Questionnaire used by the Veterans Healthcare Administration (VHA) to collect performance feedback about a contractor. The form allows an assessing official to evaluate a contractor's performance across multiple categories including quality of product/service, schedule, cost control, business relations, management of key personnel, reliability, customer support, and overall performance. The questionnaire provides rating options from Unsatisfactory to Exceptional, with a section for additional comments on performance or tasks performed.

The questionnaire must be submitted directly to Danielle Carrico at Danielle.Carrico@va.gov by 6/20/2025 at 5:00pm PT, and the responses may be used in an award decision. The form is specifically related to the Bend, OR VA Janitorial Services for Clinic solicitation (Solicitation Number: 36C26025Q0560), which is a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside opportunity under the Department of Veterans Affairs Veterans Health Administration.

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S06 36C26025Q0560 0001.pdf PDF
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VAAR 852.219-75 Word Copy for Fillout - Optional.docx DOCX document
S02 36C26025Q0560.pdf PDF

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Past Performance Questionnaire

CONTRACT TYPE (if applicable):

CONTRACT COMPLETION DATE:

1. NAME OF FIRM/AGENCY PROVIDING FEEDBACK:

CONTRACTOR NAME:

PERIOD OF PERFORMANCE:

CONTRACT AWARD DATE:

AWARDED VALUE: CURRENT CONTRACT DOLLAR VALUE:

2. NAME OF ASSESSING OFFICIAL:

EMAIL: PHONE NUMBER:

ASSOCIATION WITH FIRM BEING RATED (including role):

CONTRACT OR ORDER NUMBER (if applicable):

3. ASSESS THE FOLLOWING AREAS: (Check the appropriate box for each assessment category)

4 ADDITIONAL COMMENTS ON PERFORMANCE/ TASKS PERFORMED:

Assessment Categories Unsatisfactory Marginal Satisfactory Very Good Exceptional N/A

a. QUALITY OF PRODUCT OR SERVICE

b. SCHEDULE

c. COST CONTROL

d. BUSINESS RELATIONS

e. MANAGEMENT OF KEY PERSONNEL

f. RELIABILITY

g. CUSTOMER SUPPORT

h. OVERALL PERFORMANCE

i. OTHER AREAS:

(1)

(2)

Responses may used in an award decision by Veterans Healthcare Administration (VHA). Please submit the response directly to Danielle Carrico, Danielle.Carrico@va.gov by 6/20/2025 at 5:00pm PT. Do not send to the Contractor requesting the

Questionnaire. We greatly thank you for your assistance!

1 NAME OF FIRMAGENCY PROVIDING FEEDBACK:
PERIOD OF PERFORMANCE:
CONTRACT TYPE if applicable:
CONTRACT AWARD DATE:
CONTRACT COMPLETION DATE:
AWARDED VALUE:
CURRENT CONTRACT DOLLAR VALUE:
2 NAME OF ASSESSING OFFICIAL:
EMAIL:
PHONE NUMBER:
ASSOCIATION WITH FIRM BEING RATED including role:
CONTRACT OR ORDER NUMBER if applicable:
Assessment Categories:
Unsatisfactorya QUALITY OF PRODUCT OR SERVICE:
Marginala QUALITY OF PRODUCT OR SERVICE:
Satisfactorya QUALITY OF PRODUCT OR SERVICE:
Very Gooda QUALITY OF PRODUCT OR SERVICE:
Exceptionala QUALITY OF PRODUCT OR SERVICE:
NAa QUALITY OF PRODUCT OR SERVICE:
Unsatisfactoryb SCHEDULE:
Marginalb SCHEDULE:
Satisfactoryb SCHEDULE:
Very Goodb SCHEDULE:
Exceptionalb SCHEDULE:
NAb SCHEDULE:
Unsatisfactoryc COST CONTROL:
Marginalc COST CONTROL:
Satisfactoryc COST CONTROL:
Very Goodc COST CONTROL:
Exceptionalc COST CONTROL:
NAc COST CONTROL:
Unsatisfactoryd BUSINESS RELATIONS:
Marginald BUSINESS RELATIONS:
Satisfactoryd BUSINESS RELATIONS:
Very Goodd BUSINESS RELATIONS:
Exceptionald BUSINESS RELATIONS:
NAd BUSINESS RELATIONS:
Unsatisfactorye MANAGEMENT OF KEY PERSONNEL:
Marginale MANAGEMENT OF KEY PERSONNEL:
Satisfactorye MANAGEMENT OF KEY PERSONNEL:
Very Goode MANAGEMENT OF KEY PERSONNEL:
Exceptionale MANAGEMENT OF KEY PERSONNEL:
NAe MANAGEMENT OF KEY PERSONNEL:
Unsatisfactoryf RELIABILITY:
Marginalf RELIABILITY:
Satisfactoryf RELIABILITY:
Very Goodf RELIABILITY:
Exceptionalf RELIABILITY:
NAf RELIABILITY:
Unsatisfactoryg CUSTOMER SUPPORT:
Marginalg CUSTOMER SUPPORT:
Satisfactoryg CUSTOMER SUPPORT:
Very Goodg CUSTOMER SUPPORT:
Exceptionalg CUSTOMER SUPPORT:
NAg CUSTOMER SUPPORT:
Unsatisfactoryh OVERALL PERFORMANCE:
Marginalh OVERALL PERFORMANCE:
Satisfactoryh OVERALL PERFORMANCE:
Very Goodh OVERALL PERFORMANCE:
Exceptionalh OVERALL PERFORMANCE:
NAh OVERALL PERFORMANCE:
Unsatisfactoryi OTHER AREAS:
Marginali OTHER AREAS:
Satisfactoryi OTHER AREAS:
Very Goodi OTHER AREAS:
Exceptionali OTHER AREAS:
NAi OTHER AREAS:
1:
Unsatisfactory1:
Marginal1:
Satisfactory1:
Very Good1:
Exceptional1:
NA1:
2:
Unsatisfactory2:
Marginal2:
Satisfactory2:
Very Good2:
Exceptional2:
NA2:
4 ADDITIONAL COMMENTS:
CONTRACTOR NAME:

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