D.1 PAST PERFORMANCE SURVEY.docx
DOCX document 24 KB Posted
- Attached to
- Q523--Neuromonitoring Services
- Solicitation number
- 36C25724Q0471
About this file
This document is a Past Performance Survey for a federal contract opportunity from the Department of Veterans Affairs (VA) for Neuromonitoring Equipment and Technician Services. The VA is seeking offerors to provide these services at the North Texas Veterans Healthcare System.
The survey requests information from a reference about the past performance of the company being evaluated, including ratings on compliance with requirements, knowledge and expertise, access to personnel, scheduling process, and patient privacy protection. The reference is also asked whether they would award another contract to the firm. The completed survey must be submitted by October 23, 2024 at 12:00 PM CT via email. The related federal contract opportunity, Solicitation Number 36C25724Q0471 for Neuromonitoring Services, is a 100% Total Service-Disabled Veteran-Owned Small Business Set-Aside to be awarded by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25724Q0471 0002 - Amendment to Extend Offer Date-Post Q and A.docx | DOCX document | |
| 36C25724Q0471 - Questions and Answers.docx | DOCX document | |
| 36C25724Q0471 0001 Amendment to Extend Offer Date.docx | DOCX document | |
| D.5 QASP - NEUROMONITORING.pdf | ||
| D.6 WAGE DETERMINATION 2015-5227 rev 23 7.22.24.pdf | ||
| S02 36C25724Q0471 - Neuromonitoring Services.pdf | ||
| D.2 CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document | |
| D.4 ORGANIZATIONAL CONFLICTS OF INTEREST.docx | DOCX document | |
| D.3 CONTRACTOR CERTIFICATION OF IMMIGRATION.docx | DOCX document |
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D.1 36C25724Q0471 PAST PERFORMANCE SURVEY
Neuromonitoring Equipment and Technicians REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is seeking offerors for award of a VA contract for Neuromonitoring Equipment and Technicians at the North Texas Veterans Healthcare System. You have been identified as a reference and your comments would be appreciated. Your comments are considered Source Selection Sensitive; therefore, you are advised that the release of the names of individuals providing reference information about Offeror’s past performance is prohibited. Survey should be completed by evaluator and submitted no later than October 23, 2024 @ 12:00PM CT via email directly to brandy.riha@va.gov.
NOTE: Incomplete or unsigned surveys will not be considered.
Company being evaluated: _______________________________________________ Period of Performance:
What was the average monthly volume of the services provided? (Average number of hours worked per month?) ______________________________________ Name and title/position of evaluator:
Contact telephone number:
Contact e-mail address:
Please evaluate the past performance using only the following ratings without variation. If the rating is other than Fully Acceptable, please provide additional information in the appropriate block or in the remarks section of this form.
S = Superior Performance
V = Very Good with very few issues
F = Fully Acceptable/Good
M = Marginally Acceptable
U = Unacceptable Performance
| Please rate and provide information/comments for the following: |
| Circle/indicate selection |
| Q1. Rate how well the contractor complies with requirements and/or expectations? |
| S V F M U |
| Q2. Rate contractor’s knowledge and expertise in providing Neuromonitoring Equipment and Technician Services. |
| S V F M U |
| Q3. Rate the level of access to the contractor’s personnel. (i.e. Did they respond in a timely manner? Did they meet the requirements of being available and responding as according to the contract?) |
| S V F M U |
| Q4. Rate overall ease of contractor’s scheduling process. |
| S V F M U |
| Q5. Rate how well contractor protects the privacy of patients. |
| S V F M U |
Q6. Would you award another contract to the firm being evaluated? If no, please explain:
Yes No
Additional Remarks: Please use this space to indicate anything else you would like to say about the contractor being referenced or to list anything you especially liked or disliked about this contractor:
| Signature of Evaluator |
| Date |
File details come from the government source that posted it. Updated .