Attachment 5: PAST PERFORMANCE QUESTIONNAIRE

ATTACHMENT FIVE (5) – PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

Request for Quote: 36C24827Q0032
Veterans Integrated Service Network 8 (VISN 8)
Intraoperative Neuromonitoring (IONM) Services
Message to the assessor: Your assistance is requested by Rosetta Quinn, the Contracting Officer to assist with establishing the performance history for the Company named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed past performance questionnaire(s) to: [email protected]. If not enough space is provided, please attach additional information to this questionnaire.

1. Name of Company /Agency:

Contract or Identifying Number:
Title/Description of Contract:

Based upon the definitions below, indicate your assessment of the company’s performance. Your assessment should consider the company’s performance in accordance with the contractual requirements. Please include the period of performance and contract value: 2. Brief description of scope of work:

EVALUATION: Please rate the company using the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.
Assessment

Definition

Outstanding (O)

The company's performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the company were highly effective. The company's performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the company were effective.

Above Average (A)

Satisfactory (S)

The company's performance met contractual requirements. The contractual
performance contained some minor problems for which corrective actions taken by the offeror were satisfactory.

Unacceptable (U)

Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the company has yet to identify corrective actions or the company's proposed actions appear only marginally effective or were not fully implemented.

Completed scheduled services in a timely manner per the Performance Work Statement (PWS).
Compliance with contractual Terms and Conditions.