S02 RFP 36C10B26R0035 Attachment 2 Past Performance Questionaire.docx

APPENDIX F – SAMPLE PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE ASSESSMENT QUESTIONNAIRE

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor’s name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Prime Offeror:

POC Name:

POC Title:

Date:

POC Telephone Number:

POC FAX Number:

POC Address:

E-mail Address:

PART II. EVALUATION (To Be Completed By Point Of Contact – Respondent)

Instructions: Select the applicable evaluation rating (Exceeds, Meets, Failed) and provide a narrative explanation in the Comment section supporting the rating selected

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship ☐ Exceeds Contractual Requirements ☐ Meets Contractual Requirements ☐ Failed to Meet Contractual Requirements

Comments:

B. Effectiveness of Project Management (to include use and control of subcontractors).

☐ Exceeds Contractual Requirements ☐ Meets Contractual Requirements

C. If this was a performance-based contract, how well did the contractor perform against the contract metrics?

☐ Meets Contractual Requirements

D. Rate the contractor’s ability to identify and mitigate risks.

☐ Meets Contractual Requirements

E. Rate the contractor’s ability to manage complex projects at multiple, geographically dispersed sites, if applicable.

☐ Meets Contractual Requirements

F. Timeliness of Performance for Services and Product Deliverables, including the Administrative Aspects of Performance.

☐ Meets Contractual Requirements

G. Describe how the work under this contract is related to experience cited in number of end users and coverage requirements and devices provided.

☐ Meets Contractual Requirements

H. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest.

☐ Meets Contractual Requirements

I. Overall Satisfaction.

Explanation must be provided in Comments field below ☐ Extremely ☐ Satisfactory ☐ Unsatisfactory

J. General Comments. Provide any other relevant performance information.

K. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

L. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Past Performance Questionnaire AS AN ATTACHMENT via e-mail to Brett.Schwerin@va.gov and Terricia.Lloyd@va.gov. The subject line of the email must read 36C10B26R0035, Past Performance Questionnaire in order for the email to be successfully transmitted and received. The subject line should be in black type and is case sensitive.

Thank you for your assistance.