S02 - Attachment D5 - Past Performance Questionnaire.pdf
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- Solicitation number
- 36C25026Q0156
About this file
This document is a Past Performance Survey form used by the Department of Veterans Affairs Network 10 Contracting Office to evaluate offerors competing for contract 36C25026Q0156. The survey collects references from previous or current purchasers of the offeror's services to assess past performance capability. Responses must be submitted no later than the solicitation closing date to Michelle.Ford2@va.gov. The survey requires evaluators with sufficient knowledge of the offeror's performance to complete the assessment. Comments provided are considered source selection information and will not be shared with the offeror or parties outside the Department of Veterans Affairs.
The survey contains nine rating sections using a standardized five-point scale: Outstanding (O), Above Average (A), Satisfactory (S), Marginal (M), and Unacceptable (U). Evaluators assess contract compliance, quality of staffing candidates provided, staff continuity and turnover minimization, invoicing accuracy and timeliness, ability to resolve performance issues, issuance of cure notices or performance documentation, overall service quality satisfaction, and willingness to award future contracts. The form includes sections for identifying the company being evaluated, the evaluator's information, and contract/service details including scope, type of services, period of performance, locations, number of medical staffers provided, and approximate service value. Evaluators must provide supporting comments for each rating and sign and date the completed survey.
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ATTACHMENT D5 - PAST PERFORMANCE
SURVEY (References) Solicitation 36C25026Q0156
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 Michelle.Ford2@va.gov.
Information of company to be evaluated (i.e. the company being evaluated)
______________________________________________ Company Name/Offeror:
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: _______ ______
| ATTACHMENT 6 - PAST PERFORMANCE SURVEY (References) |
| Solicitation 36C25018Q0598 |
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