PPQ -Request form.docx
DOCX document 597 KB Posted
- Solicitation number
- 36C24826Q0450
About this file
This is a Past Performance Questionnaire form template used by the Department of Veterans Affairs to collect reference evaluations from past clients of contractor bidders. The form is completed by previous performance reference contacts and submitted directly to the contracting officer (David Hernandez at david.hernandez1@va.gov) to evaluate a contractor's suitability for prime contractor consideration on a VA contract requirement. The questionnaire utilizes a six-point rating scale aligned with FAR 42.1503 Table 42-1: Unsatisfactory (1), Marginal (2), Satisfactory (3), Very Good (4), Exceptional (5), and N/A (6). Each rating level includes specific definitions addressing whether contractual requirements were met, the nature of any performance problems identified, and the effectiveness of corrective actions taken by the contractor. Reference contacts provide ratings, remarks, printed name, title, and signature to validate their assessment of the contractor's past performance.
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| WD-FL20260211-DATED 05-18-2026.pdf | ||
| 36C24826Q0450 0003.docx | DOCX document | |
| 36C24826Q0450 0002.docx | DOCX document | |
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Text version
PAST PERFORMANCE QUESTIONNAIRE – SOLICITATION #
INSTRUCTIONS TO CONTRACTOR: Complete the CONTRACTOR INFORMATION section below and send to the point of contact listed requesting they please complete the form and submit it according to the instructions below.
INSTRUCTIONS TO REFERENCE CONTACT: The contractor named above is submitting an offer to a prime contractor for a United States Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact. Please complete this form in full. Once completed, please send the form to the Contracting Officer only by email:
Department of Veterans Affairs NCO 8 Contracting Office TO: David Hernandez Contracting Officer, Email: david.hernandez1@va.gov
REF SOLICITATION NUMBER:
Reference FAR 42.1503 Table 42-1
1 - Rating: Unsatisfactory Definition: Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor's corrective actions appear or were ineffective.
2 - Rating: Marginal Definition: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions. The Contractor's proposed actions appear only marginally effective or were not fully implemented.
3 - Rating: Satisfactory Definition: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear, or were, satisfactory.
4 - Rating: Very Good Definition: Performance meets contractual requirements and exceeds some to the Government's benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.
5 - Rating: Exceptional Definition: Performance meets contractual requirements and exceeds many to the Government's benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.
6 - N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.
Remarks:
Printed Name and Title
Signature image3.png image4.png image1.png image2.png
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