Past Performance Worksheet.docx

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE

(To be completed by References)

Request for Proposal Number: 36C24722Q0001 closing date: September 10, 2021

Submit completed Cover Sheet and Survey via email to:

Thomas Nicholls, Contract Specialist Network Contracting Office (NCO) 7 Phone: 843-789-6379 Email: Thomas.Nicholls@va.gov

Department of Veterans Affairs, RHJ VA Medical Center 109 Bee Street Charleston, SC 29401

*Do not return this form to the contractor being evaluated. It is desired that this form be submitted to the person identified above, no later than 5 days before RFQ closing date.

1. Handwritten responses are acceptable. If a response is handwritten, please print legibly.

2. If more space is needed for narrative comments, use the back of the survey or attach additional pages.

3. Your time and effort in providing this vitally important information is greatly appreciated.

GENERAL INFORMATION

Please provide the following information:

Name of Company for which you are filling out this survey:

Contract Number(s): __________________________________ Period of Performance: _________________________________ General Description of Contract Services: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contract Dollar Value: ______________ Type of Contract (firm fixed price, cost plus fixed fee, etc.): ______________

REMARKS: (Add on separate sheet.)

CONTRACTOR PERFORMANCE EVALUATION SURVEY RATING SHEET

RATING SCALE

Please use the following rating to answer the questions. If you are unable to rate any item because it was not a requirement, never an issue, or you have no knowledge of the item in question, then you should mark “N/A”.

EVALUATION CRITERIA

NOTE: For statements indicating “No Confidence” or “Substantial Confidence”, please provide and explanation in the Comments section of the survey.

CONTRACTOR PERFORMANCE EVALUATION SURVEY RATING SHEET

FOR CONTRACT: ___________________________

A. QUALITY OF PRODUCT OR SERVICE

(1) The Contractor provided a product or service that conformed to contract requirements, specifications and standards of good workmanship

(2) The Contractor submitted accurate reports.

(3) The Contractor utilized personnel who were appropriate to the effort performed.

B. COST CONTROL

(1) The Contractor performed the effort within the estimated cost/price.

(2) The Contractor submitted accurate invoices on a timely basis.

(3) The Contractor demonstrated cost efficiencies in performing the required effort.

(4) The actual costs/rates realized closely reflected the negotiated costs/rates.

C. SCHEDULE

(1) The tasks required under this effort were performed in a timely manner and in accordance with the period of performance of the contract.

(2) The Contractor was responsive to technical and/or contractual direction.

D. BUSINESS RELATIONSHIPS

(1) The Contractor demonstrated effective management over the effort performed.

(2) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) and/or Technical Point of Contact (TPOC) were apprised of technical, cost and schedule issues.

(3) The Contractor presented information and correspondence in a clear, concise and businesslike manner

(4) The Contractor promptly notified the COR, TPOC and/or Contracting Officer in a timely manner regarding urgent issues.

(5) The Contractor cooperated with the Government in providing flexible, proactive and effective recommended solutions to critical program issues.

(6) The Contractor made timely award to, and demonstrated effective management of, its subcontractors.

(7) The Contractor demonstrated an effective small/small disadvantaged business subcontracting program.

E. CUSTOMER SATISFACTION

(1) The products/services provided adequately met the needs of the program.

(2) The Contractor was able to perform with minimal or no direction from the COR or TPOC.

(3) I am satisfied with the performance of the Contractor under this effort.

F. Key Personnel

(1) The labor turnover in key personnel labor categories was minimal and did not adversely affect Contractor performance

(2) The Contractor proposed qualified personnel to fulfill the requirements of the contract.

G. OTHER:

(1) Would you award this firm another contract? ( ) Yes ( ) No If you answered “no”, provide an explanation.

(2) Was the contract terminated for default? ( ) Yes ( ) No

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