VA247-17-R-0004-005.docx

Attachment # 3

Past Performance Survey

OFFEROR INSTRUCTIONS: A separate survey must be completed for each reference. The completed surveys must be included with the offeror’s technical proposal.

EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the Offeror listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. Your comments are considered Source Selection Sensitive. The name of the individuals providing reference information is confidential and will not be released or made publicly available.

Name of Company being evaluated:

Evaluator’s Name:

Evaluator’s Company Name, Address and Phone number:

Indicate what contracts did this offeror provided for your company? Provide the total contract amount, dates of performance, and contract number.

Evaluation Questions

Comment on the overall quality of contractor’s work.

Were there any performance issues/concerns? If so, how were they handled?

If any changes were needed, was the contractor flexible in responding to those changes?