Past Performance Evaluation Questionnaire 36C24225Q0139.docx
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- Solicitation number
- 36C24225Q0139
About this file
This is a Past Performance Evaluation Questionnaire template for solicitation number 36C24225Q0139, related to a Reverse Osmosis System Lease with Maintenance and Water Quality Testing Service at the Manhattan VA Medical Center. The questionnaire is designed to gather information about previous contracts performed by potential quoters.
The template includes fields for basic contract information including customer/client details, agency points of contact, contract numbers, place of performance, period of contract, contract type, facility type, building square footage, contract value, and description of services performed. The document appears to be a blank form template that repeats three times, likely to allow vendors to submit multiple past performance references for evaluation by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 2.
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Text version
PAST PERFORMANCE EVALUATION QUESTIONNAIRE
Quoter Name: ______________________ Solicitation Number: 36C24225Q0139
BACKGROUND INFORMATION (To be completed by quoter)
Customer/Client Name/Address: _________________________________________________________
Agency Point of Contact: _________________________________________________________
Telephone Number: _________________________________________________________
Cell Phone Number: _________________________________________________________
Email: _________________________________________________________
Contract Number: _________________________________________________________
Place of Performance: _________________________________________________________
Period of Contract: _________________________________________________________
Contract Type: _________________________________________________________
Facility Type: _________________________________________________________
Gross Square Footage in Building: _________________________________________________________
Contract Value: _________________________________________________________
Description of Services Performed:
Quoter Name: ______________________ Solicitation Number: 36C24225Q0139
Customer/Client Name/Address: _________________________________________________________
Agency Point of Contact: _________________________________________________________
Telephone Number: _________________________________________________________
Cell Phone Number: _________________________________________________________
Email: _________________________________________________________
Contract Number: _________________________________________________________
Place of Performance: _________________________________________________________
Period of Contract: _________________________________________________________
Contract Type: _________________________________________________________
Facility Type: _________________________________________________________
Gross Square Footage in Building: _________________________________________________________
Contract Value: _________________________________________________________
Description of Services Performed:
Quoter Name: ______________________ Solicitation Number: 36C24225Q0139
Customer/Client Name/Address: _________________________________________________________
Agency Point of Contact: _________________________________________________________
Telephone Number: _________________________________________________________
Cell Phone Number: _________________________________________________________
Email: _________________________________________________________
Contract Number: _________________________________________________________
Place of Performance: _________________________________________________________
Period of Contract: _________________________________________________________
Contract Type: _________________________________________________________
Facility Type: _________________________________________________________
Gross Square Footage in Building: _________________________________________________________
Contract Value: _________________________________________________________
Description of Services Performed:
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