ATTACHMENT_H_-_Past_Performance_Questionnaire.docx

ATTACHMENT H: PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Solicitation Number: VA119A-16-R-0159 Vendor to forward to Customer

E-MAIL TO: Tara Flores Contracting Officer AGENCY: Department of Veterans Affairs (VA) E-MAIL: Tara.Flores@va.gov

E-MAIL TO: Caitlin Palmer Contract Specialist AGENCY: Department of Veterans Affairs (VA) E-MAIL: Caitlin.Palmer@va.gov

INFORMATION REQUEST: PAST PERFORMANCE

This office is currently in the process of soliciting a competitive service contract. [Contactor Name] has provided your name and organization as a reference regarding [Contractor Name]’s record of past performance under Contract No. [Contract No.]

PAST PERFORMANCE QUESTIONNAIRE

PART I:

Vendor’s Name: ____________________________________________________________________ Name of Person Completing the Evaluation: _____________________________________________ Telephone:____________________ E-mail: _________________ Title:________________________________________________________________________________ Company/Organization: ________________________________________________________________

Please rate the vendor in each of the following areas. Note: There is room for comments where you deem remarks would be helpful to our evaluation.

Overall satisfaction with the vendor’s performance. Would you (the reference) choose to work with this vendor again?

Rate satisfaction with the quality of service.

Rate satisfaction with resolutions vendor proposed/employed for problems encountered.

Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.

Cost control includes providing the supplies or services within the originally proposed cost.

Rate the satisfaction with vendor’s business relations with the Government.

Rate the vendor’s ability to manage the project and stay within scop, and effecitly ensure provision of quality, timely service.

Rate the vendor’s ability to manage any subcontractors under this project.

Rate whether the vendor met the small business goals set forth in their subcontracting plan, if applicable.

Rate (Rater to add any item necessary for past performance for the vendor’s specific action.)

1. 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.

1. 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.

1. Based on the vendor’s overall performance, would you award them another contract? |_| Yes |_| No If No, please explain.

1. Have you discussed any adverse past performance problems with the Vendor and given them an opportunity to comment? |_| Yes |_| No Please explain.

1. Do you file past performance information in a database that the Contracting Officer may search? |_| Yes |_| No Please explain.

1. If the contract had options, were those options exercised? |_| Yes |_| No Please explain.

1. What was the contract period of performance (i.e., when were services provided)?

1. What was the dollar value of the contract performed by the vendor?

1. Provide a brief description of the services provided by the vendor for this contract.

PART II (Editable by contractor) Offeror to Complete and forward as part of Volume III.

Name of Contracting Organization: ________________________________________________________ Contract Number:____________________________________ Task/Delivery Order Number:__________ Contract Type:___________________________ NAICS:____________ Awarded Price/Cost:____________________ Final or Projected Final Price/Cost:___________________ Description of Requirement:______________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contracting Officer’s Name:___________________________ Contracting Officer’s Number: __________ Program Manager’s Name:____________________________ Program Manager’s Number: __________ Comments: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SOURCE SELECTION SENSITIVE INFORMATION – SEE FAR 2.101 and 3.104