ATTACHMENT F - PAST PERFORMANCE REFERENCE - NX EQ AUTOTRANSFUSION UNITS.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C10X27Q0014
About this file
This file is a Past Performance Reference form template for Solicitation 36C10X27Q0014, a Request for Quote issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for NX EQ Autotransfusion Units. The form is designed to collect past performance information from offerors and includes space for three separate past performance references. Each reference section requires documentation of the offeror's or subcontractor's relevant experience, including the contracting organization, contract/task order number, contract type, awarded and final prices, delivery dates and period of performance, contracting officer and program manager contact information, and the applicable NAICS code. The form indicates "No record of relevant or recent past performance" at the top, suggesting this is a blank template awaiting completion by prospective contractors.
For each reference, offerors must provide a detailed description of work performed that specifically relates to the solicitation requirements for autotransfusion units, which are systems used to recover patients' own blood during surgical procedures. Additionally, offerors must explain any performance issues or problems that occurred during contract execution, corrective actions taken, and expected or realized results from those actions, with particular attention to any issues documented in CPARS or PPIRS reports. The form allows offerors to identify whether they performed the work as the prime contractor or as a subcontractor.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT G - PAST PERFORMANCE QUESTIONNAIRE - NX EQ AUTOTRANSFUSION UNITS.docx | DOCX document | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ AUTOTRANSFUSION UNITS.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ AUTOTRANSFUSION UNITS.docx | DOCX document | |
| ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ AUTOTRANSFUSION UNITS.docx | DOCX document | |
| ATTACHMENT A - PRICE COST SCHEDULE - NX EQ AUTOTRANSFUSION UNITS.xlsx | XLSX spreadsheet | |
| 36C10X27Q0014.docx | DOCX document | |
| ATTACHMENT E - REPORTING TOOL - NX EQ AUTOTRANSFUSION UNITS.xlsx | XLSX spreadsheet |
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Text version
ATTACHMENT F: PAST PERFORMANCE REFERENCE
NX EQ AUTOTRANSFUSION UNITS
SOLICITATION: 36C10X27Q0014
☐ No record of relevant or recent past performance.
Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 2
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
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