PRESENT PAST PERFORMANCE SURVEY.docx

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Attached to
R602--COURIER SERVICES FOR PHARMACY Federal contract opportunity
Solicitation number
36C24622Q0728
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 6

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File Type Posted
SCHEDULE OF SERVICES _ Courier.docx DOCX document
36C24622Q0728 0001.docx DOCX document
PRICE WORKSHEET Final.docx DOCX document
36C24622Q0728_2.docx DOCX document
VAAR 852.219-77 SEPT 2021 Deviation.docx DOCX document

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D.2 PRESENT/PAST PERFORMANCE SURVEY

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

Solicitation Number: 36C24622Q0769 Fuel Polishing Services

Contractor's Name: ___________________________________________________________________

Address: ___________________________________________________________________________ Telephone/Email: ____________________________________________________________________

Point of Contact: _____________________________________________________________________

Service Provided: _____________________________________________________________________

Number and type of Contracts: __________________________________________________________

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

1. RESPONDENT INFORMATION:

Name of Respondent: ___________________________Title: __________________________________

Organization: ________________________________________________________________________

Address: ____________________________________________________________________________

Email: _________________________________________

Telephone Number: ____________________________Fax Number: _____________________________

SIGNATURE______________________________________

1. EMAIL COMPLETED SURVEY FORM TO: Amarlia Van Buren: Amarlia.vanburen@va.gov

PAST AND PRESENT PERFORMANCE SURVEY

1. 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)

Contractor provided adequate supervision.
1 2 3 4 5 6 N/A
Contractor provided experienced managers and supervisors with the technical and administrative abilities to meet contract requirements.
1 2 3 4 5 6 N/A
Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.
1 2 3 4 5 6 N/A
Corrected deficiencies in timely manner and pursuant to their quality control procedures.
1 2 3 4 5 6 N/A
Provided timely resolution of contract discrepancies.
1 2 3 4 5 6 N/A
Suggested alternative approaches to problems.
1 2 3 4 5 6 N/A
Displayed initiative to solve problems.
1 2 3 4 5 6 N/A
Cooperated with Government personnel after award
1 2 3 4 5 6 N/A
Rate the overall contractor’s performance under this contract.
1 2 3 4 5 6 N/A
Contractor’s compliance with contractual terms and conditions.
1 2 3 4 5 6 N/A
Would you award another contract to this contractor? If not, explain in "remarks."
1 2 3 4 5 6 N/A

Remarks______________________________________________________________________

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