6- Past Performance Questionnaire.docx
DOCX document 15 KB Posted
- Attached to
- Bulk Oxygen Contract West Palm Beach Federal contract opportunity
- Solicitation number
- 36C24821Q0565
About this file
This document contains a past performance questionnaire and a solicitation for bulk oxygen services. The Department of Veterans Affairs West Palm Beach VA Healthcare System is seeking a licensed Florida bulk oxygen contractor to supply medical grade bulk oxygen to the medical center. The contractor must provide all components for an FDA certified bulk oxygen main supply system including rental of a 6000 gallon primary tank and 1500 gallon reserve tank, connection to the existing oxygen system, preventative maintenance, annual training, inventory management, and documentation. The contractor's business must be located within one hour of the West Palm Beach VAMC and include off-site system monitoring. Responses are due no later than March 15, 2021 via email, with the subject line including RFQ number 36C24821Q0565. The solicitation will use tiered evaluations with priority given to SDVOSB, VOSB, small business, HUBZone, 8(a), and large business concerns respectively.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment-3 SF30 36C24821Q0565 0003 Signed.pdf | ||
| Time Extention SF30 36C24821Q0565 0002 Signed.pdf | ||
| SF30 Answers to Contractor Questions 36C24821Q0565 0001 Signed.pdf | ||
| 36C24821Q0565_1.docx | DOCX document | |
| Questions and Answers 36C24821Q0565 1 of 1.pdf | ||
| 1- 36C248-21-Q-0565 Combined Synopsis Solicitation.docx | DOCX document | |
| 5- Limitations of Subcontracting Compliance Form 36C24821Q0565.docx | DOCX document | |
| 4- Evalualtion Criteria 36C24821Q0565.docx | DOCX document | |
| 36C24821Q0565.docx | DOCX document | |
| 3- Schedule 36C24821Q0565.docx | DOCX document | |
| 2- Performance Work Statement Bulk Oxygen 36C24821Q0565.docx | DOCX document |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Name of offeror: ___________________________________
Contract Information:
Name of Contractor: _________________________________ Contract Number: ___________________________
Contract Title: ________________________________________________________________________________
Type of Contract: ____________________________________ Period of Performance: ______________________
The ratings indicated below are to be supplied by the reference and not the offeror)
| Performance Elements |
| Satisfactory |
| Unsatisfactory |
1. Technical (Quality of Product or Service) (evaluation of the contractor’s technical performance or progress toward meeting requirements)
2. Schedule (evaluation of the timeliness of the contractor against milestones, delivery schedules)
3. Cost Control (evaluation of the contractor’s effectiveness in forecasting, managing, controlling cost and submitting accurate invoices)
4. Business Relations (assess the integration and coordination of all activity needed to execute the work, specifically the timeliness, completeness and quality of problem identification, corrective action, the contractor’s history of reasonable and cooperative behavior, customer satisfaction)
5. Management of Key Personnel (assess the contractor’s personnel performing the work)
6. Overall Rating
Remarks on unsatisfactory performance (Provide data supporting this observation. You may continue on separate sheet if needed.)
Would you do business with the offeror again? ________________________________________________________
Information provided by:
Name of Source: ___________________________________________________ Title: ____________________________________________________________ Mailing Address: ___________________________________________________ City, State and Zip Code: ____________________________________________ Telephone Number: ________________________________________________ Date: ____________________________________________________________
Questionnaire completed by:
Name of VA Employee: ____________________________________________ Title: ___________________________________________________________ Date: ___________________________________________________________ Signature: _______________________________________________________
File details come from the government source that posted it. Updated .