S02 Past Performance Questionnaire.docx

19 KB Posted

Attached to
Q301--Lab Anatomical Service for Fort Harrison Montana
Solicitation number
36C25926Q0242
Issued by

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This is a Past Performance Questionnaire template designed for evaluating contractor performance on federal contracts. The questionnaire requires contractors to provide comprehensive information about services performed, including detailed descriptions of objectives, scope of work, and achievements or challenges encountered. Contractors must supply performance dates, total contract value, organizational addresses, contract and task order numbers, and point of contact information. The form requests an overall performance rating in three categories—Outstanding, Satisfactory, or Unsatisfactory—with detailed commentary required for any rating other than Satisfactory. All sections must be completed with accurate and current information, signed by an authorized representative, and submitted to the contracting officer or designated point of contact by the quote deadline.

This questionnaire is being used in conjunction with RFQ 36C25926Q0242 for Lab Anatomical Pathology Services at Fort Harrison, Montana, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19. The solicitation is for medical laboratory services under NAICS code 621511 with a five-year estimated volume of approximately 88,321 basic consultations and related technical and professional component services. Quotes must be submitted to Kadarius.Griffin@va.gov and Lindsey.Zwaagstra@va.gov no later than 10:00 a.m. CST on March 20, 2026, with a firm-fixed price contract anticipated. The questionnaire serves as Volume III Past Performance evaluation material in accordance with Federal Acquisition Circular 2025-06 and RFO 52.212-2 Commercial Items evaluation criteria.

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File Type Posted
SOW Fort Harrison Anatomic Pathology Amended 0001.docx DOCX document
36C25926Q0242 0001.docx DOCX document
VA HANDBOOK APPENDIX D.pdf PDF
SOW Fort Harrison Anatomic Pathology.docx DOCX document
36C25926Q0242.docx DOCX document

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Past Performance Questionnaire Instructions:

1. Complete all sections of the questionnaire.

2. Ensure all contact information is accurate and up-to-date.

3. Have the contractor send a signed and completed questionnaire to the contracting officer or designated point of contact by the quote deadline.

1. Name of contractor being reviewed:

2. Description of Services Performed:

· Please provide a detailed description of the services performed under this contract. Include any specific objectives, scope of work, and notable achievements or challenges encountered.

· Prime contractor? Yes or no

· Complexity: ☐ HIGH ☐MEDIUM ☐LOW

3. Performance Dates:

· Start Date (MM/DD/YYYY):

· End Date (MM/DD/YYYY):

4. Total Contract Value:

· Please provide the total value of the contract (in USD):

5. Addresses:

Organization Name:

Street Address:

City:

State:

ZIP Code:

6. Contract Numbers:

· Contract Number:

· Task Order Number (if applicable):

7. Point of Contact Information:

· Name:

· Title:

· Phone Number:

· Email Address:

8. Performance Rating:

· Please rate the overall performance of the contractor according to the following criteria:

· Outstanding: Performance significantly exceeded expectations in all essential areas and accomplished goals that were not anticipated.

· Satisfactory: Performance met expectations and contract requirements.

· Unsatisfactory: Performance did not meet expectations and contract requirements.

· Please check the appropriate rating:

· ☐ Outstanding

· ☐ Satisfactory

· ☐ Unsatisfactory

· Additional Comments (if rated other than satisfactory): Lengthy explanation or justification for the given rating, including examples of the contractor's strengths or areas for improvement:

Verification:

· The information provided above is accurate and complete to the best of my knowledge. I authorize the verification of the services performed as described.

Signature: Please sign as indicated below Name:_________________________ Title:___________________________ Date:__________________________

File details come from the government source that posted it. Updated .