S02 - Attachment 4 - Past Experience Reference Questionnaire.pdf
PDF 160 KB Posted
- Attached to
- VA Magnetic Resonance Safety Expert Services
- Solicitation number
- 36C24C26Q0022
About this file
Summary: Past Experience Reference Questionnaire (PERQ)
This is a template form used by the Department of Veterans Affairs to collect past performance references from contractors submitting proposals for federal contracts. The form is designated for RFQ 36C24C26Q0022 and must be completed by both the contractor and their reference contacts, with submissions directed to Contracting Officer Lenny Flagg at Lenny.Flagg@va.gov. The reference contact must return the completed form no later than the deadline established for receipt of quotes or proposals.
The form consists of three sections: General Information completed by the contractor (including company details, contract title, period of performance, contract number, dollar value, and work description), Respondent Information completed by the reference contact (company and point of contact details), and Performance Information comprising two tables. Table 1 contains 14 evaluation criteria using a four-point scale (1=Unsatisfactory, 2=Marginal, 3=Satisfactory, 4=Very Good) covering personnel qualifications, management oversight, quality of work, problem resolution, responsiveness to changes, and overall performance, with required narrative explanations for any negative ratings. Table 2 addresses personnel-related questions including number of positions filled, hiring timelines (30 and 45-day benchmarks), resume submissions, turnover rates, replacement hiring times, disciplinary actions, and whether the reference would award future contracts. The form includes an expandable remarks section for detailed comments and explanations.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104
ATTACHMENT D.4
PAST EXPERIENCE REFERENCE QUESTIONNAIRE (PERQ)
INSTRUCTIONS TO CONTRACTOR
Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes).
Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions.
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement and has sent this form to you for a past experience contract reference. Please complete this form in full (all areas shaded in light yellow). Once completed, please send the form to the Contracting Officer via email: Lenny.Flagg@va.gov.
Department of Veterans Affairs RPO-C ATTN: Lenny Flagg, REF: RFQ 36C24C26Q0022
Email Address: Lenny.flagg@va.gov
Please return the completed form no later than the date and time set for receipt of Quotes/Proposals. If you have any questions, please contact Lenny Flagg via email. Thank you for your assistance in this matter.
GENERAL INFORMATION [completed by Contractor/Offeror]
Contractor Company Name
Street Address
Contractor Point of Contact Name City
Point of Contact Phone Number State
Reference Project / Contract Title Zip Code
Contract Period of Performance (start to finish): Email
Contract Number
Contract Dollar Value
Detailed Description of Work
Role of Contractor on This Project ☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel
(check appropriate box)
RESPONDENT INFORMATION [completed by Reference Contact]
Company Name
Street
Address
POC Name City
Phone Number State
Fax Number Zip Code
PERFORMANCE INFORMATION – Table 1: Choose the number on the scale of 1 to 4 that most accurately describes the contractor’s performance.
PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY NEGATIVE RATING(S) in the Remarks section, below (text box will expand to whatever extent is necessary).
1 2 3 4
UNSATISFACTORY MARGINAL SATISFACTORY VERY GOOD
Most of the time, contractor did not meet this metric.
Some of the time, contractor met this metric.
Most of the time, contractor met this metric.
Nearly all of the time, contractor met this metric.
# Contractor Reference: 1 2 3 4
1.
Contractor provided experienced personnel with the technical and administrative abilities needed to meet contract/project requirements? ☐ ☐ ☐ ☐
2.
Contractor hired and if necessary, replaced, qualified personnel during the contract period in accordance with contract requirements? ☐ ☐ ☐ ☐
3.
Contractor provided Management Oversight for supervisory roles, information dissemination to employees, Government, training, timely onboarding, task completion tracking, and addressing performance issues?
4.
Were contractor personnel timely and responsive in submitting documents for the background check? Timely response in completing eQUIP?
5. The Contractor’s personnel’s submitted Quality work, advice, and documents? ☐ ☐ ☐ ☐
6. Contractor provided timely resolution of contract discrepancies? ☐ ☐ ☐ ☐
7. Contractor identified problems as they occurred? ☐ ☐ ☐ ☐
8. Contractor suggested alternative approaches to problems? ☐ ☐ ☐ ☐
9. Contractor displayed initiative to solve problems? ☐ ☐ ☐ ☐
10. Contractor was responsive to contract/project changes/modifications? ☐ ☐ ☐ ☐
11. Contractor provided adequate contract/project supervision? ☐ ☐ ☐ ☐
12. Contractor paid subcontractors/suppliers/employees in a timely manner? ☐ ☐ ☐ ☐
13. Contractor cooperated with Government personnel after contract/project award? ☐ ☐ ☐ ☐
14. How would you rate the contractor's overall performance? ☐ ☐ ☐ ☐
PERFORMANCE INFORMATION – Table 2: Please answer the following questions regarding personnel.
Please provide any comments, narratives, or explanations on personnel below in the Remarks section (text box will expand to whatever extent is necessary).
# Questions Regarding Personnel Response
1. Number of positions needed to be filled under your requirement/project?
2. Were all positions filled within 30 calendar days of contract/project award?
3. Were all positions filled within 45 calendar days of contract/project award?
4. Number of Resumes presented for review on this contract/project?
5. After resume review(s), number of personnel hired and accepted under this contract/project?
6. After acceptance, how many personnel left before the contract ended (turnover)?
7. Average number of days to fill replacement personnel?
8.
Was the contractor ever issued a letter of concern, cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
9. Would you award another contract to this contractor? If not, please explain in “remarks.”
REMARKS (Please use as much space as is needed – the box will expand as you type).
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