S02 - Attachment 5 - Past Performance.pdf

PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire for Project 603-20-201 Replace Sterilization Preparation

Services (SPS) Air Handler at the Robley Rex VA Medical Center in Louisville, Kentucky.

PAST PERFORMANCE INSTRUCTIONS

The NCO 9 Network Contracting Activity has issued a solicitation for Project 603-20-201, Replace SPS

Air Handler at the Robley Rex VA Medical Center in Louisville, KY.

Past performance information will be used to evaluate proposals received. Section A is to be completed by the Offeror. Section A of the enclosed questionnaire lists the contractor who has identified your office as a source to evaluate their past performance. Section A also authorizes the release of this information to

NCO 9 Network Contracting Activity.

The Offeror must provide this entire document to each of its assessors. The Assessor shall only submit past performance questionnaires directly to the Contracting Officer, Robert Pritchard, by email at robert.pritchard2@va.gov.

Section B in its entirety is to be completed by the assessor(s). An individual assessor knowledgeable of the contractor’s quality of supplies and services rendered is requested to verify, complete the questionnaire, and submit it to the contracting office. If evaluating more than one contract for the same contractor, use a separate questionnaire for each contract being evaluated.

Because this information is critical to the evaluation process, your time and effort in providing your assessment are greatly appreciated. The questionnaire should be completed as soon as possible but not later than August 31, 2021 at 4:00 PM CST. The assessor is requested to send electronically to

(robert.pritchard2@va.gov).

Thank you in advance for your cooperation and expeditious response to this request.

mailto:robert.pritchard2@va.gov

PAST PERFORMANCE QUESTIONNAIRE

SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, before forwarding to assessors)

Solicitation Number 36C24921R0108

Project/Requirement Project 603-20-201

Customer/Agency Robley Rex VA Medical Center

1. Prospective Government Contractor’s __________________________________________________

Name and Address __________________________________________________

2. Contractor Point of Contact: __________________________________________________

3. Phone Number (with area code): __________________________________________________

4. Assessor Contract Award Number: __________________________________________________

5. Description of Services: __________________________________________________

6. Contract Award Date: _______________ Contract Amount: Initial ___________ Final___________

7. Period of Performance: __________________________________________________

ASSESSOR INFORMATION:

Assessor Name

Title

Phone Number/Email Address

Authorization is hereby granted to provide the information requested in this questionnaire to the NCO 9 Network

Contracting Activity, Murfreesboro, Tennessee.

Signature

Name and Title of Authorizing Official Date

SECTION B: Assessor's Information (to be completed by assessors).

RATING SCALE Definitions

Past Performance Evaluation Ratings

Exceptional Performance exceeded most of the contractual requirements to the government’s/client’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor exceeded expectations.

Good Performance exceeded some of the contractual requirements to the government’s/client’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were effective and timely.

Satisfactory Performance met contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal Performance did not meet some contractual requirements. The contractual performance of the element or sub-elements being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory Performance did not meet most contractual requirements and

Timely recovery or correction is not likely. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions were ineffective.

Neutral The offeror has no past performance history, or none was received for evaluation.

The questions on the survey below shall be rated per the definitions provided in the Rating Scale.

Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.

QUALITY:

Quality of technical data/report preparation efforts E G S M U N Ability to meet quality standards specified for technical performance E G S M U N

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

E G S M U N

Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements E G S M U N

(without adverse effect on performance)

SCHEDULE/TIMELINESS OF

PERFORMANCE

Compliance with contract delivery/completion schedules including any significant intermediate milestones

E G S M U N

Rate the contractor’s use of available resources to accomplish tasks identified in the contract E G S M U N

CUSTOMER SATISFACTION

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

E G S M U N

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

E G S M U N

To what extent was the contractor cooperative, professional, and concerned with the interests of the customer?

E G S M U N

Overall customer satisfaction E G S M U N

MANAGEMENT/PERSONNEL

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

E G S M U N

Government/client Property Control E G S M U N

Knowledge/expertise demonstrated by contractor personnel

E G S M U N

Ability to simultaneously manage multiple projects with multiple disciplines E G S M U N

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

E G S M U N

Effectiveness of overall management (including ability to effectively lead, manage and control the program) E G S M U N

COST/FINANCIAL MANAGEMENT

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

E G S M U N

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

Government/client

E G S M U N

SAFETY/SECURITY

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 user’s rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

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

E G S M U N

GENERAL

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 G S M U N

Compliance with contractual terms/provisions (explain if specific issues) E G S M U N

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

YES NO

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

Please provide frank 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

(attach additional pages if necessary):