Past Performance Survey.docx

This is a Past Performance Survey template for solicitation 36C26126Q0953 issued by the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 21. The survey is designed to collect reference information from past clients regarding a contractor's performance on previous contracts.

The form requires offerors to submit a separate survey for each reference directly to bruce.lundvall@va.gov. Evaluators completing the survey must provide their name, signature, company name, address, and phone number, along with details of services provided by the contractor including performance dates, dollar amounts, and contract numbers. The survey requests an overall quality of work rating using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) with supporting comments, and requires disclosure of any performance issues or concerns and how they were resolved. The underlying contract opportunity is for Metasys Building Automation System calibration, repair, and system accuracy verification services at the VA Central California Health Care System, ensuring compliance with VA, OSHA, Joint Commission, and applicable Federal regulations for environmental parameters including airflow, differential pressure, temperature, and humidity monitoring.