RFP_040ADV_22_R_0014 -Veterans Administrations Veterans Health ID Card _ Attachment J.2 _Past Performance Questionnaire.pdf

Attachment J.2 - Past Performance Questionnaire

ORGANIZATION’S PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this questionnaire and send by email to: dbracey@gpo.gov

U.S. Government Publishing Office Acquisition Services

732 North Capitol Street, NW Room A530, Stop: AS

Washington, DC 20401

Response Due Date: July 15, 2022 at 12:00 PM

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41

U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY CONTRACTOR

1. CONTRACTOR’S NAME AND

ADDRESS

3. CONTRACT NO.:

CONTRACT DATE:

4. PERIOD OF PERFORMANCE:

4. PACE OF PERFORMANCE:

5. COMPLETION DATE:

6. CONTRACT VALUE $

2. PROJECT NAME:

7. TYPE OF CONTRACT:

8. DESCRIPTION OF PROJECT’S KEY CHARACTERISTICS:

Please add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

9. NAME AND ADDRESS OF EVALUATING ORGANIZATION:

EVALUATOR’S NAME, POSITION DURING PROJECT EXECUTION (Project Manager/COR/Other)

EVALUATOR’S PHONE NUMBER

MONTHS PERFORMANCE MONITORED BY

EVALUATOR:

mailto:dbracey@gpo.gov

Please check the response code for each topic that best reflects your experience with this Contractor:

EX = Exceptional VG = Very Good S = Satisfactory MG = Marginal US

= Unsatisfactory N/O = Not Observed Quality of Products and Services- Assess the Contractor’s conformance to contract requirements.

EX VG S MG US N/O

Overall Performance- Assess the Contractor’s overall performance for the project.

EX VG S MG US N/O

Schedule- Assess the timeliness of the Contractor against the schedule of activities (as appropriate).

EX VG S MG US N/O

Technical Requirements- Assess the Contractor’s ability and capacity to fulfill the technical requirements of the contract.

EX VG S MG US N/O

Cost Control- Assess the Contractor’s willingness and ability to manage the contract budget and control costs.

EX VG S MG US N/O

Subcontracting- Assess the Contractor’s success at complying with subcontracting goals.

EX VG S MG US N/O

Customer Satisfaction- Assess the Contractor’s responsiveness to customer concerns and “user friendliness” in ROUTINE matters.

EX VG S MG US N/O

Customer Satisfaction- Assess the Contractor’s responsiveness to customer concerns and “user friendliness” in UNEXPECTED DIFFICULTIES.

EX VG S MG US N/O

Repeat Business- Assess the likelihood that you would want this Contractor to perform another contract for you in the near future.

EX VG S MG US N/O

List Contractor’s Weak Points:

List Contractor’s Strong Points:

List any other projects this Contractor has completed for you:

If an award fee contract, what was the average award fee % earned?