S02 Past Performance Questionnaire Exhibit N.pdf

Exhibit N

RLP: 36C24926R0002 Page 1 of 4

PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire for Franklin County CBOC, Frankfort, Kentucky

PAST PERFORMANCE INSTRUCTIONS

The NCO 9 Network Contracting Activity, Murfreesboro, Tennessee has issued a solicitation to provide leased space for a Franklin County CBOC, Frankfort, Kentucky.

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 9 Network

Contracting Activity, Murfreesboro, Tennessee.

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

November 3, 2025.

Assessor is requested to send electronically to Martin.Frazier@va.gov, or mail to the following address:

Attn: Martin Frazier, 1639 Medical Center Parkway, Suite 204, Murfreesboro, Tennessee 37129.

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.

LESSOR___GOVERNMENT _______

mailto:Martin.Frazier@va.gov

RLP: 36C24926R0002

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 36C24926R0002

Project/Requirement Franklin County CBOC, Frankfort, KY

Customer/Agency Department of the Veteran Affairs, NCO 9, Murfreesboro, TN 37219

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 9 Network

Contracting Activity, Murfreesboro, Tennessee

(Signature)

(Name and Title of Authorizing Official) (Date)

SECTION B: Assessors Information (to be completed by assessors.

RATING SCALE Definitions

Past Performance Evaluation Ratings

Rating Description

Acceptable (A) Based on the offeror’s performance record, the

Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

Unacceptable (U) Based on the offeror’s performance record, the

Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

The questions on 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.

QUALITY OF SERVICE

1. Rate the contractor’s compliance with contractual requirements. A U

2. Overall rating of contractor quality of service. A U

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

SCHEDULE

1. Delivery of service was within required time period specified by contract requirements. A U

2. Rate the contractor’s ability to control cost and submit invoices.

Are invoices complete, accurate, and timely? A U

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

BUSINESS RELATIONS

A U

A U

1. Overall rating of contractor’s business practices (e.g. maintaining

A positive working relationship, business ethics, timely and effectively

Resolution of any problems, etc.)

2. Rate the working relationship between contractor’s management, and your company (i.e. contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer).

3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner. A U

LESSOR___GOVERNMENT _______RLP: 36C24926R0002

RLP: 36C24926R0002

4. Rate the contractors responsiveness to customer complaint resolution. A U

5. Overall rating of contractor’s business relations. A U

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

How would you feel about awarding another contract to this contractor?

Would not hesitate to award another contract to this contractor.

Would most likely award another contract to this contractor.

Would think twice about awarding another contract to this contractor but would do so if no better alternative existed.

Do not wish to award another contract to this contractor.

Would not award another contract to this contractor.

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.

Acceptable Unacceptable

VII. General Comments:

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 or Printed Name) (Organization Name)

(Phone Number)