PRESENT-PAST PERFORMANCE SURVEY.docx

PRESENT/PAST PERFORMANCE SURVEY

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate.

Solicitation Number:

Contractor's Name:

Address:

Telephone:

Point of Contact:

Contractor Performed as the ( ) prime Contractor, or the ( ) Sub-Contractor

1. RESPONDENT INFORMATION:

Name of Respondent:_______________________________________Title:______________________________

Organization: _______________________________________________________________________

Address:____________________________________________________________________________

Telephone Number:_________________________

Fax Number:_________________________________

SIGNATURE______________________________

1. EMAIL COMPLETED SURVEY FORM TO: Richard.coutermarsh@va.gov

Or mail it to

Richard Coutermarsh NCO1/Manchester VAMC 718 Smyth Road BST Suite 105 Manchester, NH 03104

(603) 624-4366 ext. 5802

PAST AND PRESENT PERFORMANCE SURVEY

D. PERFORMANCE INFORMATION: Choose and circle the number on the scale of 1-6 that most accurately describes the contractor's performance or situation.

CODE/PERFORMANCE LEVEL

1 UNSATISFACTORY - Performance did not meet most contractual requirement. There were serious problems and the contractor's corrective actions were ineffective.

2 MARGINAL - Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

3 NONE - No record of past performance or the record is inconclusive.

4 SATISFACTORY - Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor was satisfactory.

5 VERY GOOD - Performance met all contract requirements and exceeded some to the Government's benefit. There were a few minor problems which the contractor resolved in a timely effective manner.

6 EXCEPTIONAL – Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly efficient manner.

The contractor: (1 being Very Bad and 6 being Very Good)

1. Contractor provided adequate supervision. 1 2 3 4 5 6 N/A

2. Contractor provided experienced managers and supervisors with the 1 2 3 4 5 6 N/A technical and administrative abilities to meet contract requirements.

3. Demonstrated ability to hire, maintain, and replace, if necessary, 1 2 3 4 5 6 N/A qualified personnel during the contract period.

4. Corrected deficiencies in timely manner and pursuant to their 1 2 3 4 5 6 N/A quality control procedures.

5. Provided timely resolution of contract discrepancies. 1 2 3 4 5 6 N/A

6. Suggested alternative approaches to problems. 1 2 3 4 5 6 N/A

7. Displayed initiative to solve problems. 1 2 3 4 5 6 N/A

8. Cooperated with Government personnel after award 1 2 3 4 5 6 N/A

9. Contractor’s compliance with contractual terms and conditions. 1 2 3 4 5 6 N/A

10. Rate the overall contractor’s performance under this contract. 1 2 3 4 5 6 N/A

11. Would you award another contract to this contractor? If not, Yes ( ) No ( ) explain in "remarks."

Remarks______________________________________________________________________