Past performance Questionnaire (PPQ).pdf

ATTACHMENT 2: PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire for Project 621-22-107, AE (AJP) Modernize Bldg. 108 Boiler Plant & Systems at the James H. Quillen Veteran Affairs Medical Center (VAMC), Mountain Home, TN.

PAST PERFORMANCE INSTRUCTIONS

The NCO 9 Network Contracting Activity has issued a solicitation for Project # 621-22-107, AE (AJP) Modernize Bldg. 108 Boiler Plant & Systems.

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 Activity.

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 – Diana K. Grube via email at diana.grube@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 4/5/2022 at 10:00 AM CT. Assessor is requested to send electronically to diana.grube@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.

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 36C24922R0030 Project/Requirement Project # 621-22-107, AE (AJP) Modernize Bldg. 108

Boiler Plant & Systems Customer/Agency James H. Quillen, Mountain Home VAMC

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:

6. Contract Award Date: __ Contract Amount: Initial __ _ Final_

7. Period of Performance: ______________

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 PROVIDERATIONALE FOR ASSIGNED RATING:

SCHEDULE

3. Delivery of service was within required time 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.

ACCEPTABLE UNACCEPTABLE_

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 contact 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)