S02 Attachment Three 3 PAST PERFORMANCE QUESTIONNAIRE.pdf

PDF 216 KB Posted

Attached to
CBOC Services | West Palm Beach VAMC
Solicitation number
36C24821R0092
Issued by

About this file

This document contains a past performance questionnaire template for evaluating offerors on a solicitation from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. The solicitation is for CBOC Services at the West Palm Beach VAMC. The past performance questionnaire requests ratings and narratives on an offeror's performance on previous similar contracts. It includes ratings definitions for outstanding, above average, satisfactory, and unacceptable performance. Assessors are asked to evaluate an offeror's completion of scheduled services, compliance with terms and conditions, personnel, quality control, responsiveness, problem-solving, and documentation. The overall performance rating and explanation are also requested, along with any additional comments.

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36C24821R0092 A0002.pdf PDF
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S02 Attachment Twenty Two 22 VHA Program Guide.pdf PDF
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S02 Attachment Twelve 12 Design Framework for Whole Health Implementation.pdf PDF
S02 Attachment Sixteen 16 Medical Care Memorandum Number 548 113 97 Pathology and Laboratory Medicine Service.pdf PDF
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S02 Attachment Thirty Two 32 VHA Directive 1608 Comprehensive Enviroment of Care Program.pdf PDF
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S02 Attachment Twenty Eight 28 Medical Care Memorandum Number 548 136 376 Patient Care Data Capture.pdf PDF
S02 Attachment Six 6 Davis Bacon Act Wage Determination Okeechobee.pdf PDF
S02 Attachment Six 6 Davis Bacon Act Wage Determination Boca Raton.pdf PDF
S02 Attachment Eighteen 18 Medical Care Memorandum Number 548 113 074 Point of Care Ancillary Testing Policy.pdf PDF
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S02 Attachment Two 2 CONTRACTOR RULES OF BEHAVIOR.pdf PDF
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EVALUATION: Please rate the company using the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Assessment Definition

Outstanding (O) The company's performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the company were highly effective.

Above Average (A) The company's performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the company were effective.

Satisfactory (S) The company's performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the offeror were satisfactory.

Unacceptable (U) Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the company has yet to identify corrective actions or the company's proposed actions appear only marginally effective or were not fully implemented.

ATTACHMENT THREE (3) – PAST PERFORMANCE QUESTIONNAIRE

36C248-21-R0092 Veterans Integrated Service Network 8 (VISN 8)

Message to the assessor: Your assistance is requested by Mechelle D. Reaser, the Contracting Officer to assist with establishing the performance history for the Company named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to: Mechelle.Reaser@va.gov. If not enough space is provided, please attach additional information to this questionnaire.

1. Name of Company /Agency:

Contract or Identifying Number:

Title/Description of Contract:

Based upon the definitions below, indicate your assessment of the company’s performance. Your assessment should consider the company’s performance in accordance with the contractual requirements. Please include the period of performance and contract value:

2. Brief description of scope of work:

Completed scheduled services in a timely manner per the Performance Work Statement (PWS).

O A S U

Compliance with contractual Terms and Conditions. O A S U Provided experienced personnel with the technical and administrative abilities needed to meet contract requirements.

O A S U

Demonstrated ability to hire, maintain, and replace, if necessary, personnel during the contract period.

O A S U

Provided effective quality control and/or inspection procedures to meet contract requirements.

O A S U

Corrected deficiencies in a timely manner and pursuant to the company's quality control procedures.

O A S U

Exhibited knowledge of and compliance with Government (or other) regulations and industry standards.

O A S U

How effective was the company in responding to urgent requests in a timely manner per the Performance Work Statement (PWS)?

O A S U

To what extent was the company able to solve contract performance problems without extensive guidance from procurement or technical personnel?

O A S U

Provides timely and accurate documents, records, and invoices as required by the contract.

O A S U

Would you award similar contracts to this company? Please provide explanation for response.

O A S U

Rate the company's OVERALL quality of performance under this contract O A S U

EXPLANATION OF OVERALL RATING GIVEN:

ADDITIONAL COMMENTS (as required)

Name & Signature of Assessor’s:

Company/Agency: Date:

Position Title/Grade: Phone:

Email: Fax:

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