Solicitation Attachment - Past Performance Questionnaire.pdf

ATTACHMENT 3: PAST PERFORMANCE QUESTIONNAIRE

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

Project/Requirement

Customer/Agency Department of the Veteran Affairs, NCO 5

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 5 Network Contracting Office

(Signature)

(Name and Title of Authorizing Official) (Date)

SECTION B: Assessors Information (to be completed by assessors.)

RATING SCALE Definitions

Past Performance Evaluation Ratings

Rating Description

Acceptable (A)

Based on the offeror’s performance record, the

Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

Unacceptable (U)

Based on the offeror’s performance record, the

Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

The questions on 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.

QUALITY OF SERVICE

1. Rate the contractor’s compliance with contractual requirements. A U

2. Overall rating of contractor quality of service. A U

PLEASE PROVIDE RATIONALE FOR ASSIGNED RATING:

SCHEDULE

1. Delivery of service was within required time period specified by contract requirements. A U

2. Rate the contractor’s ability to control cost and submit invoices.

Are invoices complete, accurate, and timely? A U

BUSINESS RELATIONS

1. Overall rating of contractor’s business practices (e.g. maintaining

A positive working relationship, business ethics, timely and effectively

Resolution of any problems, etc.) A U

2. Rate the working relationship between contractor’s management, and your company (i.e. contractor’s history of reasonable and cooperative behavior, commitment of customer satisfaction; concern for the interest of the customer). A U

3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner. A U

4. Rate the contractors responsiveness to customer complaint resolution. A U

5. Overall rating of contractor’s business relations. A U

How would you feel about awarding another contract to this contractor?

______ Would not hesitate to award another contract to this contractor.

______ Would most likely award another contract to this contractor.

______ Would think twice about awarding another contract to this contractor, but would do so if no better alternative existed.

______ Do not wish to award another contract to this contractor.

______ Would not award another contract to this contractor.

Overall Rating of Contractor’s performance (quality, schedule, business relations,) on contract being assessed.

Acceptable Unacceptable

VII. General Comments:

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 or Printed Name) (Organization Name)

(Phone Number) (Organization)