S02 SOL-Att-05 - Past Performance Client Questionnaire.pdf

Multiple Award Task Order Contract (MATOC) 36C25223R0071

SOURCE SELECTION SENSITIVE Page 1 of 5 36C25223R0071 Attachment 5 FAR 2.101 and 3.104.-4

Solicitation Attachment 5

Past Performance Client Questionnaire

(SAMPLE TRANSMITALL LETTER TO BE SENT FROM CONTRACTOR)

<Your Company Letterhead>

Date: ___________________

To:

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm will be submitting a proposal under a solicitation advertised by Department of Veterans Affairs, Network Contracting Office 12 (NCO 12), located at 115 South 84th Street, Suite 101, Milwaukee, WI 53214-1476.

In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance; your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible.

Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306 (e)

(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address. Do NOT return them directly to our company.

via email to: steven.helm@va.gov and anne.vossler@va.gov

If you have questions regarding the attached questionnaire, please contact Steven Helm at steven.helm@va.gov.

Please be advised that “E-Mail” is the preferred method of receiving the requested information.

Thank you for your assistance.

<Signature and Title of Offeror’s Principal>

SOURCE SELECTION SENSITIVE Page 2 of 5 36C25223R0071 Attachment 5

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 36C25223R0073 Project/Requirement Clement J. Zablocki VAMC Construction MATOC 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)

SOURCE SELECTION SENSITIVE Page 3 of 5 36C25223R0071 Attachment 5

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:

Attention to detail and quality of initial performance. (Was work done right the first time?)

E G S M U N

Provided qualified personnel and quality execution for specialized trade work

E G S M U N

Followed approved quality control plan E G S M U N

Provided effective quality control and/or inspection procedures to meet contract requirements.

E G S M U N

Corrected deficiencies in timely manner and pursuant to their quality control procedures.

E G S M U N

Adequacy/effectiveness of quality control program and adherence to contract quality control plan (without adverse effect on performance)

E G S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

Met established project schedules. E G S M U N

SOURCE SELECTION SENSITIVE Page 4 of 5 36C25223R0071 Attachment 5

Developed realistic progress schedules E G S M U N

3. CUSTOMER SATISFACTION:

Overall project 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, business-like and communication)

E G S M U N

Professionalism of contractor E G S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

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

Delegated authority to project managers and supervisors commensurate with contract requirements.

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

Provided reasonable cost and time proposals for contract changes.

E G S M U N

Paid subcontractors/suppliers in a timely manner

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 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)

SOURCE SELECTION SENSITIVE Page 5 of 5 36C25223R0071 Attachment 5

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.

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)