D.8 PAST PERFORMANCE QUESTIONNAIRE

Reference Request For Proposal (RFP) 36C25526R0066; Referral Lab Services

Vendor being evaluated:_______________________________________________________

Please provide your candid responses. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please complete this document and email it directly to michael.carson1@va.gov by:

Thank you.

ORGANIZATION INFORMATION

ORGANIZATION NAME AND

ADDRESS

POINT OF CONTACT

Name:

Email:

Phone:

Title:

BRIEF DESCRIPTION OF SERVICES PROVIDED & PERIOD OF PERFORMANCE

Please provide ratings (exceptional, very good, satisfactory, marginal, or unsatisfactory) in the following areas and add comments for anything above or below Satisfactory:

1. Overall Quality of contract performance:

Comments:

2. Vendor’s overall ability to provide pre-analytic processing, analysis, and result interpretation for clinical and anatomical pathology specimens:

Comments:

3. Vendor's quality assurance program maintained by the laboratory to include data of lost and broken specimens, delayed results, and number of tests performed:

Comments:

4. Describe ability to provide electronic transmission of all completed and partial test results:

Comments:

Any other pertinent information:

Signature:__________________________________________________________ Name/Title:_________________________________________________________