S02 - EXHIBIT M - Past Performance Questionnaire_01.pdf
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- Attached to
- X1DZ--Aberdeen Vet Center Outstation
- Solicitation number
- 36C24525R0018
About this file
This document is a Past Performance Questionnaire (Exhibit M) for a VA leasing and facilities management contract (Solicitation Number 36C24525R0018) for the Aberdeen Vet Center Outstation. The form provides detailed instructions for potential lessors to complete a comprehensive performance evaluation, requiring them to list up to five recent relevant contracts from the past five years and obtain performance assessments from previous contract managers.
The questionnaire requires evaluators to provide narratives and ratings across four key performance areas: Quality of Services, Timeliness of Performance, Business Relations, and an overall assessment of contractor strengths and weaknesses. Performance is rated using an adjectival scale ranging from Excellent to Unsatisfactory, with specific criteria defined for each rating level. The completed questionnaire must be submitted directly by VA facility personnel to Efrem.Sommer@va.gov prior to the solicitation close date, ensuring an independent and unbiased performance review.
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INSTRUCTIONS TO POTENTIAL LESSOR:
1. CONTRACT IDENTIFICATION:
a. On page 2, list up to 5 of your most recent relevant contracts, relating to Leasing of
Space or Facilities Management, for up to the last 5 years
b. Sign bottom of page 2
c. Return to Efrem.Sommer@va.gov
2. PAST/PRESENT PERFORMANCE QUESTIONNAIRE:
a. Fill out Section I on page 3
b. Provide the Questionnaire (Pages 3-7) to each identified party on page 2 with instructions to return the completed form to Efrem.Sommer@va.gov prior to the Solicitation End Date.
i. For questionnaire to remain valid, it must be received from the Identified Party below, and not potential Lessor.
RLP: 36C24525R0018 EXHIBIT M Page 1 of 7
CONTRACT IDENTIFICATION:
1. VA Facility Name: ______________________________
Contract COR or CO: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
2. VA Facility Name: ______________________________
Contract COR or CO: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
3. VA Facility Name: ______________________________
Contract COR or CO: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
4. VA Facility Name: ______________________________
Contract COR or CO: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
5. VA Facility Name: ______________________________
Contract COR or CO: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
LESSOR Signature:
Date:
Name:
Title:
RLP: 36C24525R0018 EXHIBIT M Page 2 of 7
PAST/PRESENT PERFORMANCE QUESTIONNAIRE:
SOLICITATION NUMBER – 36C24525R0018
PLEASE COMPLETE THE FOLLOWING IDENTIFYING INFORMATION AND PAST PERFORMANCE
ASSESSMENT. PLEASE SEND THE COMPLETED FORM TO EFREM SOMMER AT
EFREM.SOMMER@VA.GOV PRIOR TO THE SOLICITATION CLOSE DATE. TO REMAIN VALID,
COMPLETED FORM MUST ORIGINATE FROM VA FACILITY PERSONNEL.
Section I: CONTRACTOR IDENTIFICATION
Contractor Name: ______________________________
Contract Number: ______________________________
Period of Performance: ______________________________
Negotiated contract dollar amount: ______________________________
Current or Estimated or Final contract dollar amount: ______________________________
Describe service(s) acquired or performed: ______________________________
Section II: EVALUATOR INFORMATION
Name: ______________________________
Organization: ______________________________
VA Email: ______________________________
Relation to Contract: ______________________________
Time on Contract: ______________________________
Section III: ASSESSMENT ELEMENTS
Narrative statements are vital. Please provide a narrative for each element below and then an adjectival rating under pars. III.A2, III.B.2, III.C.2, and an overall Past/Present Performance Adjectival Rating under
RLP: 36C24525R0018 EXHIBIT M Page 3 of 7 par. III.F based on the attached Adjectival Rating Descriptions. Attach additional pages if there is insufficient space in the comment space.
Performance adjectival ratings: Choose the appropriate adjective that most accurately describes the contractor’s performance based on the descriptions below:
EXCELLENT
(Use E below)
Performance meets contractual requirements with many exceeded to the
Government’s benefit. The contractual performance of the element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.
GOOD
(Use G below)
Performance meets contractual requirements with some exceeded to the
Government’s benefit. The contractual performance of the element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.
SATISFACTORY
(Use S below)
Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective actions taken by the contractor were satisfactory.
MARGINAL
(Use M below)
Performance does not meet some contractual requirements. The contractual performance of the element 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
(Use U below)
Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
RLP: 36C24525R0018 EXHIBIT M Page 4 of 7
1) Quality of Services:
a) Narrative: Address the Contractor’s ability to provide qualified personnel (including experienced managers and/or supervisors), necessary equipment, which is properly maintained, quality control for the performance of your contract, and contractor’s compliance with contractual terms and conditions.
b) Rating: (Please provide a narrative explanation of a Marginal or Unsatisfactory rating):
2) Timeliness of performance:
a) Narrative: Address the Contractor’s ability to meet the contract’s specific response times and
Contractor’s timeliness in providing any administrative reports/documents required by your contract.
RLP: 36C24525R0018 EXHIBIT M Page 5 of 7
3) Business Relations:
a) Narrative: Address Contractor’s willingness to improve and correct noncompliance issues and concerns. Describe Contractor’s ability to correct problems and prevent or mitigate potential problems in a timely manner. Does Contractor display initiative and flexibility? Do Contractor personnel promote a strong working relationship with your agency/organization? Are Contractor personnel courteous and responsive? Do Contractor personnel interface effectively with your staff?
4) Identify the contractor’s overall strengths and weaknesses:
RLP: 36C24525R0018 EXHIBIT M Page 6 of 7
5) Given the choice, would you award to this contractor again? Please circle Yes or No.
a) If no, please explain:
6) CONTRACTOR’S OVERALL PAST/PRESENT PERFORMANCE RATING: (Please provide a narrative explanation of a Marginal or Unsatisfactory rating):
Signature:
Date:
Name:
Title:
RLP: 36C24525R0018 EXHIBIT M Page 7 of 7
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