ATTACHMENT F_PAST PERFORMANCE QUESTIONNAIRE_NX EQ Ultrasonic Aspirator System Tissue Ablation.docx
DOCX document 34 KB Posted
- Solicitation number
- 36C10X27R0005
About this file
This is a Past Performance Questionnaire template designed for the Department of Veterans Affairs Enterprise Procurement Office to evaluate offeror performance on the NX EQ Ultrasonic Aspirator System: Tissue Ablation contract (Solicitation No. 36C10X27R0005). The VA will distribute this form to up to three references from the past three years that offerors cite in their proposals. References must complete and email the questionnaire to Michael.Andrews6@va.gov with the solicitation number in the subject line.
The form evaluates offerors across four rating categories—Quality of Service, Cost Control, Timeliness of Performance, and Business Relations—using a three-point scale (1: Unsatisfactory, 2: Satisfactory, 3: Excellent) with detailed performance criteria for each level. References provide ratings based on specific performance indicators, such as contract compliance and technical excellence for Quality of Service; cost management and invoice accuracy for Cost Control; milestone achievement and schedule adherence for Timeliness of Performance; and contract management and responsiveness for Business Relations. The questionnaire also includes fields for contract details (period of performance, total value, options exercised), inquiry into adverse actions (show cause orders, stop work orders, terminations), and an overall satisfaction question asking whether the reference would work with the offeror again. All sections include space for reference comments to support evaluation decisions.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT D_TEMPLATE FOR INDUSTRY QUESTIONS_NX EQ Ultrasonic Aspirator System Tissue Ablation.xlsx | XLSX spreadsheet | |
| ATTACHMENT E_PAST PERFORMANCE REFERENCES_NX EQ Ultrasonic Aspirator System Tissue Ablation.docx | DOCX document | |
| 36C10X27R0005.docx | DOCX document | |
| ATTACHMENT A_PRICE COST SCHEDULE_NX EQ Ultrasonic Aspirator System Tissue Ablation.xlsx | XLSX spreadsheet | |
| 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 |
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
SOLICITATION NO.: 36C10X27R0005
DESCRIPTION: NX EQ Ultrasonic Aspirator System: Tissue Ablation Attachment F Past Performance Questionnaire Offerors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of 3 References from Past Three Years)
DEPARTMENT OF VETERANS AFFAIRS (VA)
ENTERPRISE PROCUREMENT OFFICE (EPO)
PAST PERFORMANCE QUESTIONNAIRE
E-MAIL completed form to: Michael.Andrews6@va.gov, ensuring that the email subject line includes “36C10X27R0005”
VA EPO is currently in the process of awarding a contract for the solicitation described above. The Offeror 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 Offeror 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 “Offeror Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this Offeror’s past performance. Thank you for your organization’s assistance in fairly evaluating Offeror proposals for this solicitation.
| 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 .