S02_D.6 ATTACHMENT 6 _Past Perormance Questionnaire 36C25526Q0259.pdf
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- Solicitation number
- 36C25526Q0259
About this file
This is a Past Performance Questionnaire template for Solicitation Number 36C25526Q0259 issued by the Department of Veterans Affairs. The form is designed to be completed by past customers or contracting officers to evaluate an offeror's performance on previous contracts.
The questionnaire requires evaluators to provide the offeror's name, contract number, contract type and dollar value, and a brief description of work performed. Evaluators rate contractor performance across 12 categories using a five-point scale: Outstanding (O), Above Average (A), Satisfactory (S), Marginal (M), and Unacceptable (U). The evaluation criteria assess compliance with contract requirements, accuracy of required reports, appropriateness of personnel used, technical expertise, schedule performance, flexibility in responding to changing needs, reliability, responsiveness to technical directions, notification of problems, issuance of cure notices or termination actions, likelihood of awarding another contract, and customer satisfaction with the end product. The form includes space for detailed comments, evaluator information (name, signature, title, company, telephone number, and date), and an additional comments section. Completed questionnaires should be emailed to stephen.showers@va.gov to expedite the past performance history establishment process.
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Text version
Attachment D.6 - Past Performance Questionnaire Solicitation Number 36C25526Q0259
PAST PERFORMANCE QUESTIONNAIRE
Offeror’s Name: ___________________________________________________
Contract Number: __________________________________________________
Contract Type and Dollar Value: _______________________________________
Brief Description of Work: _____________________________________________________________________
“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 and detailed comments for the following: Circle one
1. To what extent did the contractor comply with contract requirements? O A S M U
2. If reports were required, were they accurate in meeting contract requirements?
O A S M U
3. To what extent did the contractor use appropriate personnel for contract requirements?
O A S M U
4. To what extent did the contractor display technical expertise? O A S M U
5. To what extent was contractor able to meet the performance schedule? O A S M U
6. To what extent was contractor flexible in responding to changing needs? O A S M U
7. To what extent was the contractor reliable? O A S M U
8. To what extent was the contractor responsive to technical directions? O A S M U
Attachment D.6 - Past Performance Questionnaire Solicitation Number 36C25526Q0259
Additional Comments:
Name of Evaluator: ____________________________
Signature of Evaluator: _________________________
Title: _______________________________________
Company: ___________________________________
Telephone No.: _______________________________
Date: ________________
Your assistance is requested by the Department of Veterans Affairs to assist with establishing the performance history for the Company (Offeror) named above. In efforts to expedite receipt of the requested information, please email the complete past performance questionnaire(s) to: stephen.showers@va.gov.
9. To what extent did contractor notify you of problems or potential problems?
O A S M U
10. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.
O A S M U
11. Would you award another contract to the party being evaluated? If no, please explain:
O A S M U
12. Was the customer satisfied with the end product? If no, please explain: O A S M U mailto:Jason.Condiff@va.gov
File details come from the government source that posted it. Updated .