Past Performance Fill In Sheet -081925.docx
DOCX document 21 KB Posted
- Attached to
- NATIONAL CMOP OPERATIONAL SUPPLIES/MAILING
- Solicitation number
- 36C77025R0004_1
About this file
The document is a Past Performance Fill In Sheet for a federal contract opportunity with the Department of Veterans Affairs. The solicitation (36C77025R0004) is for a five-year Indefinite Delivery/Indefinite Quantity (IDIQ) contract to provide operational and mailing supplies for seven CMOP (Consolidated Mail Outpatient Pharmacy) locations. The form is designed for past performance references to complete, evaluating the contractor's performance across multiple dimensions including product quality, delivery, communication, and invoicing, using a 0-5 rating scale.
Key details include a deadline for submitting questions of 08/22/25 at 5 PM CST, and recent modifications to the solicitation on 08/06/25 and 08/19/25 that updated spreadsheet requirements for Murfreesboro, Hines, and Charleston CMOPs. The document provides a structured template for reference contacts to assess a contractor's past performance, with sections for agency information, contract details, performance ratings, and overall evaluation, including whether the reference would award another contract to the contractor.
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Text version
Attachment 6 – Past Performance INSTRUCTIONS TO PRIME CONTRACTOR: (Contractor submitting proposal):
Complete the CONTRACTOR INFORMATION section. Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.
Company Name
Street Address
Point of Contact
City
Point of Contact Phone Number
State
E-Mail Address
Zip Code
| Solicitation Number |
| 36C77025R0004 |
| Description of Work |
| This is a five year IDIQ contract to support all seven(7) CMOP locations with Operational (Mailing) Supplies. |
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named above is submitting a proposal for a United States Department of Veterans Affairs contract and has sent this form to you as a past performance reference contact. Please complete the following pages in full (all areas shaded in light yellow, below). Once completed, please return the form to vendor requesting the reference:
RESPONDENT INFORMATION [completed by Reference Contact] Government Agency or Company name
Street Address
POC Name
City
Phone Number
State
Fax Number
Zip Code
Contract Number
Prime or Subcontractor
Dollar Value
Period of Performance
Description of services provided
Location of services provided
Number of FTEE YOUR FIRM provided
PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below (text box will expand to whatever extent is necessary).
| 0 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| NEUTRAL |
| UNSATISFACTORY |
| MARGINAL |
| SATISFACTORY |
| GOOD |
| EXCEPTIONAL |
| No record of past performance or the record is incon-clusive. |
| Performance did not meet most contractual require-ments. There were serious problems and the contractor’s corrective actions were ineffective. |
| Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective. |
| Performance met most contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. |
| Performance met all contract requirements and exceeded some. There were a few minor problems, which the contractor resolved in a timely, effective manner. |
| Performance exceeded all contract requirements. There were no problems. |
| The Contractor … |
| 0 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 1. |
| Quality of Product called for in the contract |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 2. |
| Delivery of supplies / Product IAW the Contract |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 3. |
| Communication; |
-- Delivery delays (If applicable) was timely --Request from site for delivery changes – Responded in a timely manner
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 4. |
| Invoicing – Submitted Invoices timely and as called out in the contract |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| |_| |
| 16. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
| |_| |
| YES |
| |_| |
| NO |
| 17. |
| Would you award another contract to this contractor? If not, please explain in “remarks.” |
| |_| |
| YES |
| |_| |
| NO |
| 18. |
| OVERALL PERFORMANCE RATING: |
| |_| 0 |
| |_| 1 |
| |_| 2 |
| |_| 3 |
| |_| 4 |
| |_| 5 |
REMARKS (Please use as much space as is needed – the box will expand as you type).
I hereby certify that the information that I have reported above is accurate to the best of my knowledge.
Printed Name
E-mail address
Business Title
Signature
Date
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