S02 Sol R0036 AttH Past Performance Client Questionnaire 578-25-003.pdf
PDF 509 KB Posted
- Attached to
- Z1DA--578-25-003 Renovate Elevators B200 (Construction) at the Hines VA Hospital in Hines, IL
- Solicitation number
- 36C25225R0036_3
About this file
This document is a Past Performance Client Questionnaire for a Department of Veterans Affairs contract (Solicitation Number 36C25225R0036) to replace elevators in Building 200 at the Hines VA Hospital. The six-page form is designed to collect detailed performance feedback from previous clients, allowing the VA to evaluate a contractor's past performance across seven key assessment areas: quality, schedule/timeliness, customer satisfaction, management/personnel/labor, cost/financial management, safety/security, and general performance metrics.
The questionnaire uses an adjectival rating system ranging from Exceptional (E) to Unsatisfactory (U), with neutral/not applicable (N) as an option. Respondents are asked to rate the contractor's performance on specific subcategories within each assessment area, such as technical data preparation, compliance with schedules, end-user satisfaction, on-site management effectiveness, and ability to meet contractual terms. The form also includes open-ended sections for additional comments and a final question asking whether the respondent would work with the contractor again, providing a comprehensive evaluation tool for assessing contractor performance risk.
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Page 1 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
SOURCE SELECTION SENSITIVE
FAR 2.101 and 3.104.-4
Solicitation Attachment I
Past Performance Client Questionnaire
(SAMPLE TRANSMITALL LETTER TO BE SENT FROM CONTRACTOR TO
REFERENCE)
<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.
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 necessary.
Please send your completed questionnaire to the following address. Do NOT return them directly to our company.
If you have questions regarding the attached questionnaire, please contact Contracting Officer
Kristi Kluck, 414-844-4879. Submit responses to email: kristi.kluck3@va.gov.
Thank you for your assistance.
<Signature and Title of Offeror’s Principal> mailto:kristi.kluck3@va.gov
SOURCE SELECTION SENSITIVE
FAR 2.101 and 3.104.-4
Page 2 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
PAST PERFOMANCE QUESTIONNAIRE
1.) GENERAL INFORMATION on Contractor being evaluated
Company Being Evaluated: Point of Contact:
Title: E-mail: Phone:
Address of Record:
Contract#: Dollar Amount:
Dates of Performance:
Contractor Performed as: Prime Contractor Sub-Contractor Key Personnel
Project Title and Brief Description of Work:
*Note: If Contractor holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.
2.) RESPONDENT CLIENT INFORMATION
(Person providing comments on Contractor Performance)
Evaluator (Company and Point of Contact)
Title: E-mail: Phone:
Address of Record:
3.) TRANSMITTAL INSTRUCTIONS: E-mail completed survey to Kristi.Kluck3@va.gov, Department of Veterans Affairs, Network Contracting Office 12 (NCO 12).
mailto:Kristi.Kluck3@va.gov
Page 3 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
4.) PERFORMANCE INFORMATION: Choose the appropriate adjectival rating that most accurately describes the contractor’s performance.
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.
TO BE COMPLETED BY RESPONDENT CLIENT
PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS
YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.
1. QUALITY:
Quality of technical data/reports preparation efforts
(submittals, schedule, etc.).
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
Page 4 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
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 contract delivery/completion schedules, including intermediate milestones.
E G S M U N
Contractors use of available resources to accomplish tasks identified in the contract.
E G S M U N
3. CUSTOMER SATISFACTION:
End Users were satisfied with the final product. 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
Contractor was cooperative, businesslike, and concerned with the interests of the customer?
E G S M U N
Overall customer satisfaction. E G S M U N
4. MANAGEMENT/ PERSONNEL/LABOR
Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force.
E G S M U N
Ability to hire, apply, and retain a qualified workforce to this effort E G S M U N
Government Property Control. E G S M U N
Knowledge/expertise demonstrated by contractor personnel E G S M U N
Utilization of Small Business concerns. E G S M U N
Ability to simultaneously manage multiple projects with multiple disciplines.
Page 5 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
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
Effectiveness of overall management (including ability to effectively lead, manage and control the program)
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
Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client.
E G S M U N
If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate backup documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances
(under runs or overruns).
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 was able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.).
E G S M U N
Contractor complied with all security requirements for the project and personnel 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).
Page 6 of 6 36C25225R0036 – Attachment I Project 578-25-003 Replace Elevators in Bldg 200
Please provide frank 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):
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.
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