S02 D.4 Past Performance Questionnaire Worksheet - Locum GI Physician Services - 05-28-2026.docx
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- Solicitation number
- 36C25726Q0159
About this file
This is a Past Performance Questionnaire Worksheet for a Locum Gastroenterology (GI) Physician Services contract solicitation (RFQ 36C25726Q0159) issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17. The worksheet is a template designed to evaluate quoters' past performance as Factor 2 in the source selection process, assessing likelihood of successful contract performance based on relevancy, recency, and confidence/success metrics.
Quoters are required to provide the legal entity name(s) under which they held previous Gastroenterology Physician Services contracts, identify whether the prior contract was with a Federal, State, local government, or private agency within the last three years, and supply contact information for a reference who can verify their performance. Additional required information includes contract number(s), service dates, geographic locations where services were provided, a description of the quoter's Quality Control Plan addressing contract requirements and performance standards, and a contingency plan for replacing key personnel to ensure service continuity. This worksheet serves as a standard evaluation tool to assess vendor qualifications prior to contract award for locum physician services.
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RFQ 36C25726Q0159 – Locum GI Physician Services
D.4 Past Performance Questionnaire Worksheet
Factor 2 – Past Performance – This factor will be used to assess a quoter’s likelihood of performing successfully on this contract. Past performance will be assessed for relevancy, recent, and confidence/success.
The legal name(s) of the entity(ies) with whom the Quoter held the contract for Gastroenterology Physician Services.
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Was the contract with a Federal, State, local government, or private agency under which you have provided the same or similar services required in this solicitation within the last three (3) years.
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The name, phone number, and email address of a person at the entity with whom the Quoter held this contract who can verify the information the Quoter provides in the narrative description for this contract.
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Contract Number(s)
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The dates during which the Quoter performed the Gastroenterology Physician Services.
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In what geographic location did the Quoter provide the Gastroenterology Physician Services.
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Quality Control Plan: Description and reporting reflecting the Quoter’s plan for meeting contract requirements and performance standards.
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Contingency plan for replacing key personnel to maintain services as required under the terms of the contract.
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File details come from the government source that posted it. Updated .