S03 Solicitation Attachment B - D.2 - PPQ.docx
DOCX document 26 KB Posted
- Attached to
- Q403-MDE International Federal contract opportunity
- Solicitation number
- 36C10X22R0004
About this file
This document contains a Past Performance Questionnaire template for a medical disability examinations contract opportunity. The questionnaire is to be completed by references for offerors bidding on RFP number 36C10X21R0070 issued by the VA Strategic Acquisition Center in Frederick, Maryland. It requests ratings and comments on a contractor's performance across criteria such as quality, delivery, problem resolution, and personnel. The questionnaire also asks whether the reference has taken any adverse actions against the contractor in the past three years. This appears to be an attachment for a solicitation seeking international medical disability examination services under solicitation number 36C10X22R0004 issued by the VA Strategic Acquisition Center Frederick.
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Text version
D.2 ATTACHMENT B: PAST PERFORMANCE QUESTIONNAIRE (PPQ)
Request for Proposal (RFP) No.: 36C10X21R0070 Title: Medical Disability Examinations (MDE)s
| TO: Corey Mann, Contracting Officer | AGENCY: VA, SAC-F | |
| PHONE: 240-215-1661 | E-MAIL: Corey.Mann@va.gov |
INFORMATION REQUEST: PAST PERFORMANCE
The Department of Veterans Affairs is currently in the process of awarding a competitive service contract. [CONTRACTOR NAME] has provided this Questionnaire to you for a reference regarding [CONTRACTOR NAME]’s record of past performance under Contract No. [CONTRACT #].
Send completed questionnaires to Corey.Mann@va.gov and Jennifer.Benisek@va.gov
NOTE TO OFFERORS: If the Questionnaire is provided for subcontractor’s reference, the offeror’s name below must include both the prime and subcontractor names (e.g., contractor X, who is a subcontractor to offeror Y for this solicitation).
Contractor’s Name:
Name of Person Completing the Evaluation:
Telephone: E-mail:
Title:
Company/Organization:
Please rate the contractor in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.
· Not Applicable: N/A
· 1: Performance clearly below the contract performance standard or requirement
| · 2: | Performance occasionally does not meet minimum contract performance standard or requirement |
| · 3: | Performance that meets the minimum contract performance standard or requirement |
| · 4: | Performance that meets and occasionally exceeds the contract performance standard or requirement |
| · 5: | Performance that almost always exceeds the contract performance standard or requirement |
| 1. Overall quality/satisfaction |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Overall satisfaction with the Contractor’s performance.
| 2. Delivery performance |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.
| 3. Satisfaction with the quality of service delivered |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.
| 4. Satisfaction with problem resolution |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
This includes the contractor’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.
| 5. Satisfaction with the quality of contractor personnel |
| N/A |_| |
| 1 |_| |
| 2 |_| |
| 3 |_| |
| 4 |_| |
| 5 |_| |
Rate the quality of the contractor’s staff in executing the project work scope.
6. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years?
|_| Yes |_| No If Yes, please explain.
7. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions? |_| Yes |_| No If Yes, please explain.
8. Based on the contractor’s overall performance, would you award them another contract?
|_| Yes |_| No If No, please explain.
9. Have you discussed any adverse past performance problems with the Contractor and given them an opportunity to comment? |_| Yes |_| No Please explain.
10. Do you file past performance information in a database that the Contracting Officer may search?|_| Yes |_| No Please explain.
11. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.
12. What was the contract period of performance (i.e., when were services provided)?
13. What was the dollar value of the contract performed by the contractor?
14. Provide a brief description of the services provided by the contractor for this contract.
Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Contractor’s past performance by the evaluator. Please provide information on any adverse performance by the contractor and the corrective actions taken.
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