36C24419R0101-006.docx
DOCX document 19 KB Posted
- Attached to
- VISN-Wide Direct Delivery Pharmacy Supply Federal contract opportunity
- Solicitation number
- 36C24419R0101
About this file
This document contains a past performance questionnaire and information about a pre-solicitation notice for a federal contract opportunity. The past performance questionnaire is seeking input on an offeror's performance in providing home delivery of prescribed medical and surgical products for the Department of Veterans Affairs. Respondents are asked to rate the offeror's past performance as satisfactory, unsatisfactory, or not applicable in areas of quality, management, and any general comments.
The pre-solicitation notice is for a VISN-wide direct delivery pharmacy supply contract to provide direct shipment of medical and surgical supplies to VA healthcare facilities and prescribed veteran patients' homes within VA Veterans Integrated Service Network 4. The contractor will be required to provide an extensive item catalog of available supplies and fulfill orders within 2-3 business days of receipt through an online ordering system. The online platform must be HIPAA compliant and allow separate accounts for each healthcare system. The solicitation will include the full product list, delivery locations, statement of work, and response requirements.
36C24419R0101 Attachment 5 Past Performance Questionnaire.docx
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24419D0085-000.docx | DOCX document | |
| 36C24419R0101-0001000.docx | DOCX document | |
| 36C24419R0101-003.xlsx | XLSX spreadsheet | |
| 36C24419R0101-002.pdf | ||
| 36C24419R0101-005.pdf | ||
| 36C24419R0101-007.pdf | ||
| 36C24419R0101-004.pdf | ||
| 36C24419R0101-001.docx | DOCX document | |
| 36C24419R0101-000.docx | DOCX document | |
| 36C24419R0101-000.docx | DOCX document |
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Text version
Past Performance Questionnaire The Department of Veterans Affairs is evaluating a proposal submitted by _________________________ [Offeror’s name], hereafter referred to as “Offeror,” to provide Home delivery of prescribed medical/surgical products for the VA. Offeror has provided this questionnaire to you so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.
Any information you provide in this questionnaire is considered Source Selection Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release the your name or the names of other individuals providing reference information about Offeror’s past performance.
Instructions: Be honest. Provide an assessment of Offeror’s past performance by checking the box of one the following rating options. You are encouraged to write comments as often as you’d like.
Rating Options:
Satisfactory—Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.
Unsatisfactory—Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.
Not Applicable—Unable to provide a meaningful assessment.
When you are finished, please email your completed questionnaire to Kevin.balser@va.gov .
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Performance Assessment
1. Reference Information Company Name: _______________________________________________________________________ Your Name: ___________________________________________________________________________ Contract Number (if Government): ________________________________________________________ Period of Performance: Start Date:_______________________ End Date:________________________ Scope of Services (e.g., contract dollar value, geographic coverage area, frequency of services, etc.):
2. Quality of performance Assess Offeror’s quality of performance in these areas:
| Satisfactory |
| Unsatisfactory |
| N/A |
Conformance to contract specifications
Standards of workmanship (technical, professional, safety, and the like)
Timely deliveries
Quality of products delivered (Was the right product delivered in the proper condition)
3. Management performance Assess Offeror’s contract management performance in these areas:
| Satisfactory |
| Unsatisfactory |
| N/A |
Management responsiveness (timeliness, reliability, cooperation, etc.)
Management of program (coordination, use of resources, communication, risk management, etc.)
Management of conflicts or issues (reactive, provides good solutions, flexible to changing needs, etc.)
4. General comments
Assessor’s Signature:_____________________________________ Date:_____________________
THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!
Source Selection Information—See FAR 2.101 and 3.104
File details come from the government source that posted it. Updated .