ATTACHMENT G - PAST PERFORMANCE QUESTIONNAIRE - MULTITHERAPY SYSTEMS_36C10G25R0037 Amend 0001.docx
DOCX document 29 KB Posted
- Attached to
- 6515--NX EQ Multitherapy Systems: Neuromuscular Stimulator-Ultrasound Therapy System (VA-25-00031555)
- Solicitation number
- 36C10G25R0037
About this file
The file is a Past Performance Questionnaire for a Department of Veterans Affairs (VA) Strategic Acquisition Center solicitation (No. 36C10G25R0037) for Multitherapy Systems. The solicitation seeks Enovis Vectra Neo brand name or equal neuromuscular stimulator-ultrasound therapy systems for VA medical facilities nationwide. The procurement is set aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) and will be a single award requirements contract with one 12-month base year and four 12-month option years.
Key solicitation details include a requirement for systems with specific salient characteristics such as multiple electrotherapy waveforms, two electrical stimulation channels, color touchscreen, ultrasound frequencies of 1MHz and 3MHz, and a 5cm2 soundhead. Vendors must submit proposals for all Contract Line Item Numbers (CLINs) by June 11, 2025, at 12 PM ET to Contracting Officer Kristal Hall. The evaluation will assess design features, performance capabilities, and overall product quality. The past performance questionnaire is designed to gather reference information about potential vendors' quality of service, cost control, timeliness, and business relations from previous contract experiences.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C10G25R0037 0001_1.docx | DOCX document | |
| 36C10G25R0037 0001.pdf | ||
| ATTACHMENT D - SOLICITATION PROVISIONS - MULTITHERAPY SYSTEMS.docx | DOCX document | |
| ATTACHMENT E - REPORTING TOOL - NX EQ MULTITHERAPY SYSTEMS.xlsx | XLSX spreadsheet | |
| ATTACHMENT B- CONTRACT ADMINISTRATION - NX EQ MULTITHERAPY SYSTEMS.docx | DOCX document | |
| ATTACHMENT C- CONTRACT CLAUSES - MULTITHERAPY SYSTEMS.docx | DOCX document | |
| ATTACHMENT A - PRICE COST SCHEDULE - NX EQ MULTITHERAPY SYSTEMS.xlsx | XLSX spreadsheet | |
| 36C10G25R0037.docx | DOCX document | |
| ATTACHMENT F - PAST PERFORMANCE REFERENCE MULTITHERAPY SYSTEMS.docx | DOCX document | |
| ATTACHMENT G - PAST PERFORMANCE QUESTIONNAIRE - MULTITHERAPY SYSTEMS.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment G Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0037
DESCRIPTION: NX EQ Multitherapy Systems – Enovis Vectra Neo® Brand Name or Equal
Vendors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of three references from past three years)
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
TO: Alanna Wilson, Alanna.Wilson@va.gov and Anthony Zibolski, Anthony.Zibolski@va.gov
VA SAC is currently in the process of awarding a contract for the solicitation described above. The Vendor identified below has provided your organization’s name as a reference under the contract described below:
Offeror Name:
(Insert Offeror’s Name Here)
| Contract Number: |
| (Insert Applicable Contract Number Here) |
Please rate the Vendor in each of the categories on this questionnaire. See “Rating Guidelines” section for detailed description of categories and ratings. There is room for comments where you deem remarks would be helpful to our evaluation (see ‘Comment from Reference’ under “Vendor Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this Vendor’s past performance. Thank you for your organization’s assistance in fairly evaluating Vendor proposals for this solicitation.
Please E-mail Questionnaire to Alanna.Wilson@va.gov and Anthony.Zibolski@va.gov by June 11, 2025, at 12 PM ET.
| Name of Reference: |
| (Reference Complete These Sections) |
Title of Reference:
Phone Number:
E-Mail Address:
Name of Organization:
Contract Period of Performance (Month/Day/Year Begin and End):
Total Contract Value (Base and All Option Years):
Options Exercised on Contract (Yes/No)?
Brief Description of Services/Commodity Provided by Offeror:
Show Cause Order Issued on Contract (Yes/No)?
Stop Work Order Issued on Contract (Yes/No)?
Termination for Convenience, Cause, or Default Issued on Contract (Yes/No)?
Rating Guidelines:
| Rating |
| Quality of Service |
| Cost Control |
| Timeliness of Performance |
| Business Relations |
| 1: Unsatisfactory |
| Offeror is not in compliance and has jeopardized achievement of contract objectives |
| Offeror is unable to manage costs effectively |
| Offeror delays have jeopardized performance |
| Responses to inquiries and issues are not effective |
| 2: Satisfactory |
| Minor inefficiencies and errors have been identified |
| Offeror is usually effective in managing costs |
| Offeror is usually effective in meeting milestones and delivery schedule |
| Responses to inquiries and issues is usually effective |
| 3: Excellent |
| Offeror is in compliance with contract requirements and delivers quality services |
| Offeror is effective in managing costs and submits proper invoices |
| Offeror is effective in meeting and exceeding milestones and delivery schedule |
| Responses to inquiries have been effective and/or exceeded expectations and established deadlines |
Offeror Evaluation:
| Rating (List Number Based on Rating Guidelines Above) |
| Category |
| Description |
| Quality of Service |
| In compliance with contract requirements, submits accurate reports/deliverables, has effective personnel, and has achieved/maintained technical excellence: |
Comment from Reference: _______________________
| Cost Control |
| Has achieved efficiencies in costs, managed costs effectively, and has submitted timely/accurate invoices with supporting documentation: |
| Timeliness of Performance |
| Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule: |
| Business Relations |
| Has maintained effective management of contract, has exhibited reasonable/cooperative behavior, is responsive to contract requirements, is responsive to inquiries/issues, and is proactive about resolving problems: |
| |_| YES |_| NO |
| Overall Satisfaction |
| Would you (reference) choose to work with this offeror again? |
File details come from the government source that posted it. Updated .