36W79718R0003-006.docx

SPV-5 Attachment E

Past Performance Information

Past performance is an evaluation Sub-factor for this contract. Offeror shall provide data that represents the past performance capabilities of their organization. This information must be provided on Attachments E and F. Data represents how Contractor may be utilized in determining whether the work performed for these references is relevant to the work performed under the VA SPV contract. Offeror will be required to submit contact information on current customers for interviews by the Government. Other data that must be provided if available to evaluate past performance is:

a) Warehouse external sanitation reports and scores.

b) Metrics used by contractor to monitor customer satisfaction with service.

Make additional copies of Attachment E as needed.

Use additional paper as needed to complete Attachment F.

Attachment E: Past Performance Reference Form

OFFEROR’S Name:

Please fill out one form for each of your five (three for each Contractor member of a teamed effort) most recent healthcare prime vendor or program accounts. This form may be duplicated. The Government intends to contact these references, verify data, and/or request additional information on Offeror’s performance.

1. Customer Name:

Address:

2. Point of Contact Name:

Job Title:

Telephone Number:

Email Address:

3. Contact Information:

a. Is this a Prime Vendor Account?

b. Is this Account affiliated with a Group Buying/Purchasing Organization?

If yes, specify organization:

c. How long has this account been a customer of Offeror?

d. Number of Deliveries per Week:

e. Estimated Annual Purchases:

4. Size and Type of Facility: Check all applicable

a. Type of Facility.

Private |_| Public |_| Acute Care Hospital |_| Long Term Care Facility |_| Nursing Home |_| Retirement/Assisted Living |_|

b. Size of Facility:

Daily Census:

Average Daily Meals Served:

c. Type of Foodservice: Check all applicable Tray Service Cook Serve: |_| or Tray Service Cold Plate/Retherm |_| Room Service: |_|

5. Has this customer been surveyed by Offeror for satisfaction with Offeror’s performance?

Attachment E - Past Performance Page 2 of 2