PP_Questionnaire.pdf
PDF 267 KB Posted
- Attached to
- H212 Fire Alarm Inspections, Testing, Maintenance & Repairs - Walla Walla VA - Dept of Veterans Affairs
- Solicitation number
- 36C26025Q0599
About this file
The document is a Past Performance Questionnaire for a federal contract related to fire alarm inspections, testing, maintenance, and repairs at the Walla Walla VA Medical Center and Lewiston Community-Based Outpatient Clinic. The questionnaire is designed for collecting performance feedback from previous clients, with assessment categories including quality of product/service, schedule, cost control, business relations, management of key personnel, reliability, customer support, and overall performance. The form requests respondents to rate performance levels from Unsatisfactory to Exceptional across these categories, with space for additional comments.
The questionnaire is specifically for contract opportunity 36C26025Q0599, which involves fire alarm system services with a base year from 8/15/25 to 8/14/26 and two potential option years extending through 8/14/28. Responses must be submitted directly to Danielle Carrico at danielle.carrico@va.gov by 8/1/25 at 5:30pm PT, and may be used in an award decision by the Veterans Healthcare Administration (VHA). The document provides a structured template for collecting detailed performance feedback that will likely inform future contract award decisions.
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Text version
Past Performance Questionnaire
CONTRACT TYPE (if applicable):
CONTRACT COMPLETION DATE:
1. NAME OF FIRM/AGENCY PROVIDING FEEDBACK:
CONTRACTOR NAME:
PERIOD OF PERFORMANCE:
CONTRACT AWARD DATE:
AWARDED VALUE: CURRENT CONTRACT DOLLAR VALUE:
2. NAME OF ASSESSING OFFICIAL:
EMAIL: PHONE NUMBER:
ASSOCIATION WITH FIRM BEING RATED (including role):
CONTRACT OR ORDER NUMBER (if applicable):
3. ASSESS THE FOLLOWING AREAS: (Check the appropriate box for each assessment category)
4 TASKS PERFORMED AND ADDITIONAL COMMENTS:
Assessment Categories Unsatisfactory Marginal Satisfactory Very Good Exceptional N/A
a. QUALITY OF PRODUCT OR SERVICE
b. SCHEDULE
c. COST CONTROL
d. BUSINESS RELATIONS
e. MANAGEMENT OF KEY PERSONNEL
f. RELIABILITY
g. CUSTOMER SUPPORT
h. OVERALL PERFORMANCE
i. OTHER AREAS:
(1)
(2)
Responses may used in an award decision by Veterans Healthcare Administration (VHA). Please submit the response directly to Danielle Carrico, danielle.carrico@va.gov by 8/1/25 at 5:30pm PT. Do not send to the Contractor requesting the
Questionnaire. We greatly thank you for your assistance!
36C26025Q0599
| 1 NAME OF FIRMAGENCY PROVIDING FEEDBACK: |
| PERIOD OF PERFORMANCE: |
| CONTRACT TYPE if applicable: |
| CONTRACT AWARD DATE: |
| CONTRACT COMPLETION DATE: |
| AWARDED VALUE: |
| CURRENT CONTRACT DOLLAR VALUE: |
| 2 NAME OF ASSESSING OFFICIAL: |
| EMAIL: |
| PHONE NUMBER: |
| ASSOCIATION WITH FIRM BEING RATED including role: |
| CONTRACT OR ORDER NUMBER if applicable: |
| Assessment Categories: |
| Unsatisfactorya QUALITY OF PRODUCT OR SERVICE: |
| Marginala QUALITY OF PRODUCT OR SERVICE: |
| Satisfactorya QUALITY OF PRODUCT OR SERVICE: |
| Very Gooda QUALITY OF PRODUCT OR SERVICE: |
| Exceptionala QUALITY OF PRODUCT OR SERVICE: |
| NAa QUALITY OF PRODUCT OR SERVICE: |
| Unsatisfactoryb SCHEDULE: |
| Marginalb SCHEDULE: |
| Satisfactoryb SCHEDULE: |
| Very Goodb SCHEDULE: |
| Exceptionalb SCHEDULE: |
| NAb SCHEDULE: |
| Unsatisfactoryc COST CONTROL: |
| Marginalc COST CONTROL: |
| Satisfactoryc COST CONTROL: |
| Very Goodc COST CONTROL: |
| Exceptionalc COST CONTROL: |
| NAc COST CONTROL: |
| Unsatisfactoryd BUSINESS RELATIONS: |
| Marginald BUSINESS RELATIONS: |
| Satisfactoryd BUSINESS RELATIONS: |
| Very Goodd BUSINESS RELATIONS: |
| Exceptionald BUSINESS RELATIONS: |
| NAd BUSINESS RELATIONS: |
| Unsatisfactorye MANAGEMENT OF KEY PERSONNEL: |
| Marginale MANAGEMENT OF KEY PERSONNEL: |
| Satisfactorye MANAGEMENT OF KEY PERSONNEL: |
| Very Goode MANAGEMENT OF KEY PERSONNEL: |
| Exceptionale MANAGEMENT OF KEY PERSONNEL: |
| NAe MANAGEMENT OF KEY PERSONNEL: |
| Unsatisfactoryf RELIABILITY: |
| Marginalf RELIABILITY: |
| Satisfactoryf RELIABILITY: |
| Very Goodf RELIABILITY: |
| Exceptionalf RELIABILITY: |
| NAf RELIABILITY: |
| Unsatisfactoryg CUSTOMER SUPPORT: |
| Marginalg CUSTOMER SUPPORT: |
| Satisfactoryg CUSTOMER SUPPORT: |
| Very Goodg CUSTOMER SUPPORT: |
| Exceptionalg CUSTOMER SUPPORT: |
| NAg CUSTOMER SUPPORT: |
| Unsatisfactoryh OVERALL PERFORMANCE: |
| Marginalh OVERALL PERFORMANCE: |
| Satisfactoryh OVERALL PERFORMANCE: |
| Very Goodh OVERALL PERFORMANCE: |
| Exceptionalh OVERALL PERFORMANCE: |
| NAh OVERALL PERFORMANCE: |
| Unsatisfactoryi OTHER AREAS: |
| Marginali OTHER AREAS: |
| Satisfactoryi OTHER AREAS: |
| Very Goodi OTHER AREAS: |
| Exceptionali OTHER AREAS: |
| NAi OTHER AREAS: |
| 1: |
| Unsatisfactory1: |
| Marginal1: |
| Satisfactory1: |
| Very Good1: |
| Exceptional1: |
| NA1: |
| 2: |
| Unsatisfactory2: |
| Marginal2: |
| Satisfactory2: |
| Very Good2: |
| Exceptional2: |
| NA2: |
| 4 ADDITIONAL COMMENTS: |
| CONTRACTOR NAME: |
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