Past Performance Questionnaire rev.pdf
PDF 78 KB Posted
- Attached to
- J066--SAM 940 Instruments
- Solicitation number
- 36C24526Q0790
About this file
This is a Past Performance Questionnaire template used by the Department of Veterans Affairs to evaluate offerors for calibration, maintenance, and repair services. The questionnaire is designed to gather reference information from past clients who have contracted with the offeror for similar services. Respondents are asked to assess the offeror's overall quality of performance using one of four rating options: Exceptional, Satisfactory, Unsatisfactory, or Not Applicable. An "Exceptional" rating indicates the offeror exceeded most contractual requirements with no issues, while "Satisfactory" means the offeror met all requirements with minor issues that were effectively corrected. An "Unsatisfactory" rating applies when the offeror failed to meet contractual requirements with significant problems and ineffective corrective actions. Respondents who provide "Exceptional" or "Unsatisfactory" ratings are required to provide brief narratives explaining their rationale.
The questionnaire includes space for respondent comments on the quality of performance and general observations about the offeror. Respondents must provide their company name, personal name, title, and email address, along with the date of submission. All information provided is treated as evaluation information exempt from Freedom of Information Act disclosure, with the Department of Veterans Affairs prohibited from releasing respondent names or identifying information. The template contains a single performance assessment question focused on quality of performance, with additional sections for supplementary comments and respondent identification details.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24526Q0790.pdf | ||
| Supplemental Instructions - SAM 940 instruments.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
The Department of Veterans Affairs is evaluating a quote [Offeror’s name here], hereafter referred to as “Offeror,” for calibration, maintenance, and repair services in accordance with the
PWS. Offeror has provided your name so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.
Any information you provide in this questionnaire is considered Evaluation Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release your name or the names of other individuals providing reference information about Offeror’s past performance.
Instructions: Provide an assessment of the Offeror’s past performance by checking the box with one of the following rating options. You are encouraged to write comments as often as you’d like. If your assessment is “Exceptional” or “Unsatisfactory,” then please provide a brief narrative that explains your rationale for the rating.
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Rating Options:
Exceptional—Offeror’s performance exceeded most contractual requirements and performance was accomplished with no issues or concerns.
Satisfactory—Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.
Unsatisfactory—Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.
Not Applicable—Unable to provide a meaningful assessment.
Performance Assessment
1. Quality of performance
a. What is your overall assessment of the quality of the Offeror’s performance?
Exceptional Satisfactory Unsatisfactory N/A
Comments:
2. General comments:
_____________________________ Date:_____________ Company Name:
Assessor’s Name:
Title:
Assessor’s Email: __________________________
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
File details come from the government source that posted it. Updated .