S02 - Attachment D1 - Past Performance Survey.pdf

ATTACHMENT 1 - PAST PERFORMANCE SURVEY

(References) Solicitation 36C25023Q0759

REFERENCE INSTRUCTIONS: Network 10 Contracting Office is considering the offeror listed below for award of a Department of Veterans Affairs Contract. As part of the offeror’s evaluation, the offeror’s past performance will be evaluated. You have been identified as a previous/current purchaser of the offeror’s services, and your comments regarding the offeror’s past performance can provide vital insights into offeror’s future contract performance. Please note that your comments are considered source selection information, and will not be shared in any way with the offeror or any party outside the Department of Veterans Affairs. This survey should be completed by an evaluator with sufficient knowledge of the offeror’s performance. It must be submitted no later than the closing date of the solicitation by email to cierra.joshua@va.gov.

Information of company to be evaluated (i.e. the company being evaluated)

Company Name: ______________________________________________

Company Address: ______________________________________________

Information of Evaluator

Evaluator Name and Title: _______________________________________

Company Name: _______________________________________

Phone Number: _______________________________________

Address: _______________________________________

Information on contract/service assessed for purpose of this evaluation

Contract Number (if applicable): _______________________________________

Scope of work:

Type of services provided:

Period of performance: From to

Location(s) where services were provided:

Approximate number of medical staffers provided during period of performance:

Approximate value of services provided during period of performance: $

Please evaluate the past performance using only the following ratings without variation. Please provide supporting comments explaining why you rated the offeror/contractor the way you did.

“O” = Outstanding = Performance greatly exceeded the contract requirements

“A” = Above Average = Performance exceeded the contract requirements

“S” = Satisfactory = Performance met the contract requirements

“M” = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory

“U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements

Please rate and provide information/comments for the following: Circle one

1. To what extent did the contractor comply with the requirements of the contract, agreement, or business arrangement?

O A S M U

Comments:___________________________________________________________________________________________

2. How would you assess the contractor’s performance in providing quality staffing candidates capable of meeting contractual needs throughout performance?

O A S M U

Comments:___________________________________________________________________________________________

3. How would you assess the contractor’s performance in ensuring continuity in staffers and minimization of staffer turnover during contract performance?

O A S M U

Comments:___________________________________________________________________________________________

4. How would you rate the contractor’s invoicing accuracy and timeliness during contract performance? O A S M U

Comments:___________________________________________________________________________________________

5. How would you assess the contractor’s ability to resolve any performance issues?

O A S M U

Comments:___________________________________________________________________________________________

6. Were any cure notices, show cause letters, suspension of payment, terminations, or other notices/documentation of subpar performance issued? If yes, please explain. Yes No

Comments:___________________________________________________________________________________________

7. Were you satisfied with the overall quality of services provided?

Yes No

Comments:___________________________________________________________________________________________

8. Would you award another contract to the party being evaluated? If no, please explain: Yes No

Comments:___________________________________________________________________________________________

9. Additional Comments:

Signature of Evaluator: ____________________________________________

Name of Evaluator: ________________________________________________

Date: _______ ______