Past Performance Questionnaire.rtf
RTF text file 209 KB Posted
- Attached to
- Ambulance Services - Beckley VA Medical Center
- Solicitation number
- 36C24525R0043
About this file
The document is a Past Performance Questionnaire used to evaluate a contractor's performance for a contract with the Department of Veterans Affairs (VA), Network Contracting Office 5 (NCO 5), specifically related to the Ambulance Services - Beckley VA Medical Center solicitation (36C24525R0043). The questionnaire provides a comprehensive assessment framework with rating scales for evaluating contractor performance across three primary dimensions: Quality of Service, Schedule, and Business Relations.
The evaluation uses a binary rating system of Acceptable (A) or Unacceptable (U) to assess the contractor's performance, with sections for rating compliance with contractual requirements, delivery timeframes, cost control, invoice accuracy, business practices, management relationship, report submission, and customer complaint resolution. The form includes space for assessors to provide detailed rationale for ratings and an overall recommendation on whether they would award another contract to the contractor, which serves as a critical input for future procurement decisions and vendor performance tracking.
Text of this file
ATTACHMENT E: PAST PERFORMANCE QUESTIONNAIRE
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
Project/Requirement
Customer/Agency Department of the Veteran Affairs, NCO 5
Prospective Government Contractor’s Name and Address:
| Contractor Point of Contact: |
| Phone number (with area code): |
| Assessor Contract Award number: |
| Description of Services provided under contract: |
| Contract award date: | Contract Amount: Initial | Final |
| Period of Performance or Delivery Date: |
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
Authorization is hereby granted to provide the information requested in this questionnaire to NCO 5 Network Contracting Office
(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 (A) 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 (U) 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.
A U
2. Overall rating of contractor quality of service.
A U
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
SCHEDULE
1. Delivery of service was within required time period specified by contract requirements.
A
U
2. Rate the contractor’s ability to control cost and submit invoices.
Are invoices complete, accurate, and timely? A U PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
BUSINESS RELATIONS
Overall rating of contractor’s business practices (e.g. maintaining A positive working relationship, business ethics, timely and effectively
| Resolution of any problems, etc.) | A | U |
| 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). | A | U |
| Rate the contractor's ability to submit required reports |
and/or invoices in a timely manner. A U
Rate the contractors responsiveness to customer
| complaint resolution. | A | U | |
| Overall rating of contractor’s business relations. | A | U PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING: |
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. |
PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:
Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.
Acceptable Unacceptable
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) (Organization)
Other files
| File | Type | Posted |
|---|---|---|
| S06 Amendment 36C24525R0043 0002.docx | DOCX document | |
| S06 Amendment 36C24525R0043 0001.docx | DOCX document | |
| Wage Determination - Beckley.docx | DOCX document | |
| S02 RFP 36C24525R0043 Final.docx | DOCX document |
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