S02 Past Performance Questionnaire.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C25220R0023
About this file
This document contains a past performance questionnaire for a federal solicitation seeking special mode transportation services. The Department of Veterans Affairs in Milwaukee, Wisconsin is soliciting proposals for patient transportation services for the Milwaukee VA Medical Center, to be provided twenty-four hours a day, seven days a week. The contractor must furnish wheelchair vans and sedan transportation, with approximately 70% of transports occurring within Milwaukee County. The contract will have a single firm fixed price award for a five-year ordering period under NAICS code 485991. This is a 100% small business set-aside being conducted by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12. Offerors must provide completed past performance questionnaires from references to address quality, timeliness, customer satisfaction, management, cost, safety, and general performance for evaluation.
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ATTACHMENT 2: PAST PERFORMANCE QUESTIONNAIRE
SUBJECT: Past Performance Questionnaire for Milwaukee Area Special Mode Transportation Services.
PAST PERFORMANCE INSTRUCTIONS
The NCO 12 Network Contracting Activity, Milwaukee, Wisconsin has issued a solicitation to provide patient transportation services for the Milwaukee VAMC.
Past performance information will be used to evaluate proposals received. Section A is to be completed by the Offeror. Section A of the enclosed questionnaire lists the contractor who has identified your office as a source to evaluate their past performance. Section A also authorizes release of this information to NCO 12 Network Contracting Activity.
The Offeror must provide this entire document to each of its assessors. The Offeror shall only submit with its proposal (by the closing date of the Solicitation) copies of Section A of the questionnaire as provided to the assessors.
Section B in its entirety is to be completed by the assessor(s). An individual assessor knowledgeable of the contractor’s quality of supplies and services rendered is requested to verify, complete the questionnaire, and submit to the Contracting Office. If evaluating more than one contract for the same contractor, use a separate questionnaire for each contract being evaluated.
Because this information is critical to the evaluation process, your time and effort in providing your assessment is greatly appreciated. The questionnaire should be completed as soon as possible but not later than proposal due date in Block 8 of the SF1449. Assessor is requested to send electronically to maureen.falaschi@va.gov. Assessor: Please do not send this information to the Offeror being evaluated.
Thank you in advance for your cooperation and expeditious response to this request.
PAST PERFORMANCE QUESTIONNAIRE
SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to assessors)
| Solicitation Number |
| 36C252-20-R-0023 |
| Project/Requirement |
| Milwaukee Area Special Mode Transportation Services |
| Customer/Agency |
| Department of the Veteran Affairs, NCO 12, Milwaukee, WI 53214 |
1. Prospective Government Contractor’s______________________________________
| Name and Address: | ______________________________________ | |
| ______________________________________ | ||
| ______________________________________ |
2. Contractor Point of Contact: ___________________________________________
3. Phone number (with area code):___________________________________________
4. Assessor Contract Award number: _________________________________________
5. Description of Services provided under contract: ________________________________________________________________________
6. Contract award date: ___________ Contract Amount: Initial Final
7. Period of Performance or Delivery Date: _________________________
ASSESSOR INFORMATION:
Assessor Name
Title
Phone Number/Email Address
8. Authorization is hereby granted to provide the information requested in this questionnaire to NCO 12 Network Contracting Activity, Milwaukee, WI.
(Signature)
| _____________________________________________ | __________________________ | |
| (Name and Title of Authorizing Official) | (Date) |
SECTION B: Assessors Information (to be completed by assessors.
RATING SCALE Definitions
| Exceptional (E) |
| The Offeror exceeded the majority of our expectations or requirements and met all other expectations or requirements. |
| Good (G) |
| The Offeror exceeded some of our expectations or requirements and met all other expectations or requirements. |
| Satisfactory (S) |
| The Offeror met all of our expectations or requirements. |
| Marginal (M) |
| The Offeror failed to meet some of our expectations or requirements. |
| Unsatisfactory (U) |
| The Offeror failed to meet most of our expectations or requirements. |
| Neutral / Not Applicable or Unknown (N) |
| No performance record identifiable within the area of evaluation. |
The questions in the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.
1. QUALITY:
| Overall quality of services provided |
| E |
| G |
| S |
| M |
| U |
| N |
| Quality of driving staff and attendants |
| E |
| G |
| S |
| M |
| U |
| N |
| Quality of vehicle fleet |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to meet quality standards specified for technical performance |
| E |
| G |
| S |
| M |
| U |
| N |
| Timeliness/effectiveness of contract problem resolution without extensive customer guidance |
| E |
| G |
| S |
| M |
| U |
| N |
| Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) |
| E |
| G |
| S |
| M |
| U |
| N |
2. SCHEDULE/TIMELINESS OF PERFORMANCE:
| Compliance with patient pickup and drop-off times |
| E |
| G |
| S |
| M |
| U |
| N |
| Rate the contractor’s use of available resources to accomplish tasks identified in the contract |
| E |
| G |
| S |
| M |
| U |
| N |
3. CUSTOMER SATISFACTION:
| Overall passenger satisfaction |
| E |
| G |
| S |
| M |
| U |
| N |
| Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) |
| E |
| G |
| S |
| M |
| U |
| N |
| Professionalism of contractor |
| E |
| G |
| S |
| M |
| U |
| N |
4. MANAGEMENT/ PERSONNEL/LABOR
| Management effectiveness (i.e. management of drivers, attendants, vehicles, and transportation services) |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to hire, apply, and retain a qualified workforce to this effort |
| E |
| G |
| S |
| M |
| U |
| N |
| Knowledge/expertise demonstrated by contractor personnel |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to simultaneously manage multiple passenger pickups |
| E |
| G |
| S |
| M |
| U |
| N |
| Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes |
| E |
| G |
| S |
| M |
| U |
| N |
5. COST/FINANCIAL MANAGEMENT
| Ability to meet the terms and conditions within the contractually agreed price(s) |
| E |
| G |
| S |
| M |
| U |
| N |
Have there been any indications that the contractor has had any financial problems? If yes, please explain below.
Yes
No
6. SAFETY/SECURITY
| Contractor’s ability to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues |
| E |
| G |
| S |
| M |
| U |
| N |
| Contractor compliance with all security requirements. |
| E |
| G |
| S |
| M |
| U |
| N |
7. GENERAL
| Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). |
| E |
| G |
| S |
| M |
| U |
| N |
| Compliance with contractual terms/provisions (explain if specific issues) |
| E |
| G |
| S |
| M |
| U |
| N |
Would you hire or work with this firm again? (If no, please explain below)
Yes
No
| In summary, provide an overall rating for the work performed by this contractor. |
| E |
| G |
| S |
| M |
| U |
| N |
Please provide straightforward responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (attach additional pages if necessary):
ASSESSOR:
Identify your role in the contract award or administration and the period of your involvement.
| Role |
| Period of Involvement |
Contract Specialist/Contracting Officer
Technical Project Lead/Project Officer
OTHERS
________________________________________ _______________________________ (Signature) (Date)
| _______________________________________________________________________ | (Typed Name/Title) | |
| ________________________________________ | _______________________________ | |
| (Phone Number) | (Organization) |
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