ATTACHMENT E_PAST PERFORMANCE REFERENCES_NX EQ Ultrasonic Aspirator System Tissue Ablation.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C10X27R0005
About this file
This is a Past Performance References form for solicitation 36C10X27R0005 issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for the NX EQ Ultrasonic Aspirator System: Tissue Ablation acquisition. The form is a template designed to capture three past performance references from offerors, requiring submission of relevant and recent contract performance examples demonstrating experience with similar medical device equipment supply and delivery.
The form requests detailed information for each reference including the company performing the work, relationship to the offeror (prime or subcontractor), contracting organization name, contract/task order number, contract type, awarded and final prices, delivery periods, contracting officer and program manager contact information, NAICS code, and CPARS completion status. Offerors must provide a concise description of the requirement explaining how the work performed is relevant to this solicitation's requirements, and detailed performance narrative addressing any issues encountered, corrective actions implemented, and results achieved. The document notes at the top that there is "no record of relevant or recent past performance" and provides three blank reference sections for offerors to complete during proposal submission.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT D_TEMPLATE FOR INDUSTRY QUESTIONS_NX EQ Ultrasonic Aspirator System Tissue Ablation.xlsx | XLSX spreadsheet | |
| 36C10X27R0005.docx | DOCX document | |
| ATTACHMENT A_PRICE COST SCHEDULE_NX EQ Ultrasonic Aspirator System Tissue Ablation.xlsx | XLSX spreadsheet | |
| ATTACHMENT F_PAST PERFORMANCE QUESTIONNAIRE_NX EQ Ultrasonic Aspirator System Tissue Ablation.docx | DOCX document | |
| 36C10X27R0005 - RFP.docx | DOCX document | |
| ATTACHMENT B_PRODUCT DESCRIPTION_NX EQ Ultrasonic Aspirator System Tissue Ablation.docx | DOCX document | |
| ATTACHMENT C_SALES REPORTING TOOL_NX EQ Ultrasonic Aspirator System Tissue Ablation.xlsx | XLSX spreadsheet |
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ATTACHMENT E: PAST PERFORMANCE REFERENCES
NX EQ Ultrasonic Aspirator System: Tissue Ablation
SOLICITATION: 36C10X27R0005
☐ 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 Completed: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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 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 Completed: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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 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 Completed: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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 report for this reference are to be addressed.]
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