S02- AE Past Performance Questionnaire.docx

DOCX document 26 KB Posted Feb 2, 2026

Attached to: C1DA--528A6-26-604 Bath Dry Sprinklers
Solicitation number: 36C24226R0073
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 2

About this file

Written by GovTribe AI · Feb 2, 2026

This is a Past Performance Questionnaire template designed for evaluating Architect-Engineering (AE) firm performance on federal contracts. The document is structured for both contractors and clients to complete, requiring contractors to provide detailed information about their firm, work performed, contract specifics, and project description in Blocks 1-4, while clients provide evaluation ratings and narrative comments in Blocks 5-8. The questionnaire uses a six-point performance scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, and Not Available) to assess contractor performance across seven major categories: Quality (technical data preparation, quality standards, problem resolution, and quality control); Schedule/Timeliness of Performance (delivery schedule compliance and resource utilization); Customer Satisfaction (end-user satisfaction, contractor responsiveness, cooperation, and overall satisfaction); Management/Personnel/Labor (on-site management, workforce qualifications, government property control, personnel expertise, small business utilization, multi-project management, change incorporation, and overall management effectiveness); Cost/Financial Management (price compliance, cost-saving innovations, invoice timeliness and accuracy, accounting system adequacy, termination history, and financial stability); Safety/Security (safety environment maintenance and security compliance); and General categories (emergency response capability, contractual compliance, and overall performance rating).

The questionnaire requires narrative explanations for any Unsatisfactory or Marginal ratings and includes sections for detailed strengths, weaknesses, deficiencies, and additional comments to support performance risk evaluation. The form is completed by a client representative who provides their name, title, contact information, and signature with date, making it suitable for use in evaluating past performance on the VA's dry sprinkler system design projects at Bath and Canandaigua VA Medical Centers, which will be procured under the Brooks Act with a small business size standard of $25.5 million.

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Other files

File	Type	Posted
5 528A6-26-604 Bath Dry Sprinklers AE Statement of Work.pdf	PDF	Feb 20, 2026
36C24226R0073_1.docx	DOCX document	Feb 20, 2026
36C24226R0073.docx	DOCX document	Feb 2, 2026

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PAST PERFORMANCE QUESTIONNAIRE

Solicitation Number:

Project Title:

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

	1. Contractor Information
Firm Name:	CAGE Code:
Address:	DUNs Number:

Phone Number: Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number: Delivery/Task Order Number (if applicable):

Contract Type: |_| Firm Fixed Price |_| Cost Reimbursement |_| Other (Please specify):

Contract Title: Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work |_| High |_| Med |_| Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

Exceptional (Outstanding) Very Good (Above Average)

Satisfactory

Marginal

Unsatisfactory

Not Available

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

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 effectiveSection D: Performance Information: Choose the letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS.

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.

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

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

No record of past performance or the record is inconclusive.

1. QUALITY:

a) Quality of technical data/report preparation efforts

E VG S M U N

a.1. Comments:

b) Ability to meet quality standards specified for technical performance

E VG S M U N

b.1. Comments:

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance

E VG S M U N

c.1. Comments:

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E VG S M U N

d.1. Comments:

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E VG S M U N

2.a.1 Comments:

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

E VG S M U N

2.b.1. Comments:

3. CUSTOMER SATISFACTION:

a) To what extent were the end users satisfied with the project?

E VG S M U N

3. a.1. Comments:

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E VG S M U N

3.b.1. Comments:

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

E VG S M U N

3.c.1. Comments:

d) Overall customer satisfaction

E VG S M U N

3.d.1 Comments:

4. MANAGEMENT/ PERSONNEL/LABOR

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

E VG S M U N

4.a.1. Comments:

b) Ability to hire, apply, and retain a qualified workforce to this effort

E VG S M U N

4.b.1 Comments:

c) Government Property Control

E VG S M U N

4.c.1. Comments:

d) Knowledge/expertise demonstrated by contractor personnel

E VG S M U N

4.d.1. Comments:

e) Utilization of Small Business concerns

E VG S M U N

4.e.1. Comments:

f) Ability to simultaneously manage multiple projects with multiple disciplines

E VG S M U N

4.f.1. Comments:

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

E VG S M U N

4.g.1. Comments:

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program)

E VG S M U N

4.h.1. Comments:

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

E VG S M U N

5.a.1. Comments:

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG S M U N

5.b.1. Comments:

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

E VG S M U N

5.c.1. Comments:

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

Yes No

5.d.1. Comments:

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

5.e.1. Comments:

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes No

5.f.1 Comments:

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U N

6.a.1 Comments:

b) Contractor complied with all security requirements for the project and personnel security requirements.

E VG S M U N

6.b.1. Comments:

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E VG S M U N

7.a.1. Comments:

b) Compliance with contractual terms/provisions (explain if specific issues)

E VG S M U N

7.b.1. Comments:

c) Would you hire or work with this firm again? (If no, please explain below)

Yes No

7.c.1. Comments:

d) In summary, provide an overall rating for the work performed by this contractor.

E VG S M U N

7.d.1. Comments:

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________STRENGTHS:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________WEAKNESSES:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DEFICIENCIES:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ COMMENTS:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Past Performance Information provided by: __________________________________________________ (Printed Name)

Signature: ________________________________________ Date: ____________________________ Organization: _____________________________________ Phone: ____________________________

File details come from the government source that posted it. Updated Feb 2, 2026.