ATTACHMENT_H_-_Past_Performance_Questionnaire.docx
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- Solicitation number
- VA119A16R0159
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Attachment H - Past Performance Questionnaire
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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.
| N/A |
| Not Applicable |
| U |
| Unsatisfactory – Performance does not meet most contractual requirements and recovery was not likely in a timely manner. |
| M |
| Marginal – Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the Contract has not yet identified corrective actions. Performance that meets the minimum contract performance standard or requirement |
| S |
| Satisfactory – Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory. |
| VG |
| Very Good – Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor was effective. |
| E |
| Exceptional – Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor was highly effective. |
| a. Overall quality/satisfaction |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Overall satisfaction with the vendor’s performance. Would you (the reference) choose to work with this vendor again?
| a1. Satisfaction of quality of service delivered |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate satisfaction with the quality of service.
| a2. Satisfaction with problem resolutions |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate satisfaction with resolutions vendor proposed/employed for problems encountered.
| b. Delivery/Schedule performance |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.
| c. Cost Control |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Cost control includes providing the supplies or services within the originally proposed cost.
| d. Satisfaction Business Relations |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate the satisfaction with vendor’s business relations with the Government.
| e. Satisfaction with Management |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate the vendor’s ability to manage the project and stay within scop, and effecitly ensure provision of quality, timely service.
| e1. Satisfaction with Subcontractor Management |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate the vendor’s ability to manage any subcontractors under this project.
| f. Usage of Small Business |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate whether the vendor met the small business goals set forth in their subcontracting plan, if applicable.
| g. Other Areas |
| N/A |_| |
| U |_| |
| M |_| |
| S |_| |
| VG |_| |
| E |_| |
Rate XXX (add any item necessary for past performance for your 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
Vendor to Complete and Forward as part of Volume III. to Contract Specialist at HYPERLINK "mailto:caitlin.palmer@va.gov" caitlin.palmer@va.gov and Contracting Officer at HYPERLINK "mailto:tara.flores@va.gov" tara.flores@va.gov 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
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