S02 RFI 36C25223Q0003 Att4 Past Performance Questionaire 556-23-100 Campus Utility.pdf

RFI 36C25223Q0003 Page 1 of 5

Attachment 4: Past Performance Questionnaire

Project 556-23-100 Campus-Wide Land and Utility Survey

Past Performance Client Questionnaire

RFI 36C25223R0003

Attn: Department of Veteran Affairs Contracting Officer:

The James A. Lovell Federal Health Care Center is currently procuring a stand-alone survey and mapping service contract for Project 556-23-100 Campus-Wide Land and Utility Survey.

The Source Selection Evaluation Board (SSEB) is seeking Past Performance Reviews from previous customers for this solicitation. Your facility is registered as a previous customer for this company for services of similar scope of work for these solicitations. We ask that you please review the items listed below and provide some detailed past performance reviews.

In accordance with Federal Acquisition Regulations (FAR), the SSEB will include your review of this firm's past performance in the development of our selections for interview and/or selection for negotiations for this procurement. Your candid response to the attached questionnaire will assist the evaluation team in their reviews. Please complete the enclosed questionnaire as thoroughly as possible NLT Friday, October 28, 2022.

Please send your completed questionnaire to the following address. Do NOT “cc” your evaluations to the firm being evaluated.

Preferred via email to: Kristi.Kluck3@va.gov.

or via postal to Great Lakes Acquisition Center (GLAC) Department of Veterans Affairs

Attn: Kristi Kluck

115 S 84th Street, Suite 101

Milwaukee WI 53214-1476.

If you have questions regarding the attached questionnaire, or require assistance, please contact Kristi Kluck at (414) 844-4879.

mailto:Kristi.Kluck3@va.gov

RFI 36C25223Q0003 Page 2 of 5

PAST PERFOMANCE QUESTIONNAIRE

1.) GENERAL INFORMATION on Contractor being evaluated

Name of Contractor:

City / State:

Point of Contact: Title:

E-mail: ______________

A. Project Title and Brief Description of Work:

Contract#: Dollar Amount:

Dates of Performance: ______

B. Project Title and Brief Description of Work:

C. Project Title and Brief Description of Work:

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D. Project Title and Brief Description of Work:

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2.) RESPONDENT CLIENT INFORMATION

(Person providing comments on Contractor Performance)

Respondent Name: Title:

Facility: ___________________________________

E-mail: ______________________________ Office phone: _______________

3.) TRANSMITTAL INSTRUCTIONS: E-mail completed survey to Kristi Kluck, (NCO 12) at

Kristi.Kluck3@va.gov.

4.) PERFORMANCE INFORMATION: Choose the appropriate adjectival rating that most accurately describes the contractor’s performance. Please provide frank responses to the questions above (if applicable) and/or additional remarks.

Exceptional (E) Based on the Offeror’s overall past performance subfactor ratings, essentially no doubt exists that the Offeror will successfully perform ABOVE AND BEYOND the required effort.

Good (G) Based on the Offeror’s overall past performance subfactor ratings, little doubt exists that the Offeror will successfully perform ALL the required effort.

Satisfactory (S) Based on the Offeror’s performance record, some doubt exists that the Offeror will successfully perform MOST of the required effort.

Marginal (M) Based on the Offeror’s overall past performance subfactor ratings, substantial doubt exists that the Offeror will successfully perform MOST the required effort. Changes to the Offeror’s existing processes may be necessary in order to achieve contract requirements.

Unsatisfactory (U) Based on the Offeror’s overall past performance subfactor ratings, extreme doubt exists that the Offeror will successfully perform the required effort.

Neutral / Not Applicable or Unknown (N)

No performance record identifiable within the area of evaluation.

mailto:Kristi.Kluck3@va.gov

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PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. TEAM MANAGEMENT: E / G/ S/ M / U / N for SURVEYING & MAPPING

PERFORMANCE:

2. FIELD WORK / REPORTS / FINAL SURVEYS: E / G/ S/ M / U / N for

SURVEYING & MAPPING PERFORMANCE:

Reviewer’s Signature, Date