2.4.1-A0006_Attachment 2 - Past Performanceand Experience Form_Clean.docx
DOCX document 49 KB Posted
- Attached to
- ICE TELERADIOLOGY SERVICES
- Solicitation number
- 70CDCR26R00000016
- Issued by
-
Immigration and Customs Enforcement
About this file
This is a Past Performance and Experience Form template for use in responding to the ICE Teleradiology Services solicitation (70CDCR26R00000016). The form is designed as a blank template for offerors to complete and submit as part of their proposal evaluation criteria. It serves as a standardized tool for contractors to document and present their relevant experience and past performance on similar teleradiology service contracts, allowing the government to assess organizational capability and track record in delivering comparable services to federal agencies. The template was revised as part of Amendment A0006, which made various updates to the RFP documentation, extended the proposal submission deadline to December 1, 2026, and provided government responses to industry questions. Contractors should complete this form in accordance with the specific evaluation criteria and page limitations outlined in the RFP's technical evaluation section to substantiate their qualifications for providing teleradiology services to ICE's Health Service Corps.
View the file
Other files
Show all 33
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT 2 – PAST PERFORMANCE AND EXPERIENCE FORM
INSTRUCTIONS
This is a cover page and does not count against the page limitations. Offeror input is prohibited on the cover page. Offerors shall provide responses to all items in the below tables in the “Offeror Response” columns ONLY. Offerors shall not revise the information in the “Contract Reference Required Information” columns, add rows to the tables, change the font size, or make any other changes or manipulate this document in any fashion. However, offerors may change the height of the rows if needed to ensure the offeror’s response properly fits in the designated space. Note, the government will NOT re-manipulate the row height to ensure the offeror’s entire response is visible. It is incumbent on the offeror to ensure their entire response is properly displayed.
[END OF COVER PAGE]
[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
Contract Reference #1
| Contract Reference Required Information |
| Offeror Response |
Title of Effort
Government or commercial contracting activity Point of Contact (POC), telephone number, and email. Note, the government may send a Past Performance Questionnaire to the customer POC listed for each reference. As such, offerors are encouraged to ensure they submit the most up-to-date customer contact information.
Name, UEI, and CAGE code of company who performed the effort
Was performance as a Prime or Subcontractor?
Contract/Purchase Order (PO)/Blanket Purchase Agreement (BPA)/Indefinite Delivery Indefinite Quantity (IDIQ) Number
BPA Call/Task Order (TO)/Delivery Order (DO) Number
Contract Type (Firm Fixed Price, Labor Hour, Time & Material, etc.)
Date of Award
Period of Performance Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the performance period for the duration of the subcontractor effort or the BPA Call/TO/DO.
Total Value of Contract Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the applicable dollar value of the work performed as opposed to a total contract/ceiling value.
Number of facilities supported and locations.
Annual Imaging Volume
Contract Reference #1 – Predecessor, Affiliate, or Parent Company Explanation Contract Reference Required Information As noted in the RFP, offeror’s may also submit past performance information for predecessor, affiliate, or parent companies. Offerors must explain the difference between the primary offering entity and the predecessor, affiliate, or parent company when submitting past performance information for predecessor, affiliate, or parent companies.
Offeror Response
Contract Reference #1 - Description of Effort
Description of work, scope, and responsibilities of the offeror along with, and brief explanation of how the contract reference is recent, relevant (similar in scope and magnitude to the PWS requirements), and valid. Offerors shall provide a clear explanation of their exact contribution to the effort for each Past Performance contract reference. As a reminder, at least one of the contract references submitted must be for work performed by the Prime, JV, or CTA partner, i.e. not a parent company, affiliate, subcontractor etc.
Offeror Response
Contract Reference #2
| Contract Reference Required Information |
| Offeror Response |
Title of Effort
Government or commercial contracting activity Point of Contact (POC), telephone number, and email. Note, the government may send a Past Performance Questionnaire to the customer POC listed for each reference. As such, offerors are encouraged to ensure they submit the most up-to-date customer contact information.
Name, UEI, and CAGE code of company who performed the effort
Was performance as a Prime or Subcontractor?
Contract/Purchase Order (PO)/Blanket Purchase Agreement (BPA)/Indefinite Delivery Indefinite Quantity (IDIQ) Number
BPA Call/Task Order (TO)/Delivery Order (DO) Number
Contract Type
Date of Award
Period of Performance Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the performance period for the duration of the subcontractor effort or the BPA Call/TO/DO.
Total Value of Contract Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the applicable dollar value of the work performed as opposed to a total contract/ceiling value.
Number facilities supported and locations.
Annual Imaging Volume
Contract Reference #2 – Predecessor, Affiliate, or Parent Company Explanation
As noted in the RFP, offeror’s may also submit past performance information for predecessor, affiliate, or parent companies. Offerors must explain the difference between the primary offering entity and the predecessor, affiliate, or parent company when submitting past performance information for predecessor, affiliate, or parent companies.
Offeror Response
Contract Reference #2 - Description of Effort
Description of work, scope, and responsibilities of the offeror along with, and brief explanation of how the contract reference is recent, relevant (similar in scope and magnitude to the PWS requirements), and valid. Offerors shall provide a clear explanation of their exact contribution to the effort for each Past Performance contract reference. As a reminder, at least one of the contract references submitted must be for work performed by the Prime, JV, or CTA partner, i.e. not a parent company, affiliate, subcontractor etc.
Offeror Response
Contract Reference #3
| Contract Reference Required Information |
| Offeror Response |
Title of Effort
Government or commercial contracting activity Point of Contact (POC), telephone number, and email. Note, the government may send a Past Performance Questionnaire to the customer POC listed for each reference. As such, offerors are encouraged to ensure they submit the most up-to-date customer contact information.
Name, UEI, and CAGE code of company who performed the effort
Was performance as a Prime or Subcontractor?
Contract/Purchase Order (PO)/Blanket Purchase Agreement (BPA)/Indefinite Delivery Indefinite Quantity (IDIQ) Number
BPA Call/Task Order (TO)/Delivery Order (DO) Number
Contract Type
Date of Award
Period of Performance Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the performance period for the duration of the subcontractor effort or the BPA Call/TO/DO.
Total Value of Contract Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the applicable dollar value of the work performed as opposed to a total contract/ceiling value.
Number of facilities supported and locations
Annual Imaging Volume
Contract Reference #3 – Predecessor, Affiliate, or Parent Company Explanation
As noted in the RFP, offeror’s may also submit past performance information for predecessor, affiliate, or parent companies. Offerors must explain the difference between the primary offering entity and the predecessor, affiliate, or parent company when submitting past performance information for predecessor, affiliate, or parent companies.
Offeror Response
Contract Reference #3 - Description of Effort
Description of work, scope, and responsibilities of the offeror along with, and brief explanation of how the contract reference is recent, relevant (similar in scope and magnitude to the PWS requirements), and valid. Offerors shall provide a clear explanation of their exact contribution to the effort for each Past Performance contract reference. As a reminder, at least one of the contract references submitted must be for work performed by the Prime, JV, or CTA partner, i.e. not a parent company, affiliate, subcontractor etc.
Offeror Response
Contract Reference #4
| Contract Reference Required Information |
| Offeror Response |
Title of Effort
Government or commercial contracting activity Point of Contact (POC), telephone number, and email. Note, the government may send a Past Performance Questionnaire to the customer POC listed for each reference. As such, offerors are encouraged to ensure they submit the most up-to-date customer contact information.
Name, UEI, and CAGE code of company who performed the effort
Was performance as a Prime or Subcontractor?
Contract/Purchase Order (PO)/Blanket Purchase Agreement (BPA)/Indefinite Delivery Indefinite Quantity (IDIQ) Number
BPA Call/Task Order (TO)/Delivery Order (DO) Number
Contract Type
Date of Award
Period of Performance Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the performance period for the duration of the subcontractor effort or the BPA Call/TO/DO.
Total Value of Contract Inclusive of All Options If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the applicable dollar value of the work performed as opposed to a total contract/ceiling value.
Number of facilities supported and locations.
Annual Imaging Volume
Contract Reference #4 – Predecessor, Affiliate, or Parent Company Explanation
As noted in the RFP, offeror’s may also submit past performance information for predecessor, affiliate, or parent companies. Offerors must explain the difference between the primary offering entity and the predecessor, affiliate, or parent company when submitting past performance information for predecessor, affiliate, or parent companies.
Offeror Response
Contract Reference #4 - Description of Effort
Description of work, scope, and responsibilities of the offeror along with, and brief explanation of how the contract reference is recent, relevant (similar in scope and magnitude to the PWS requirements), and valid. Offerors shall provide a clear explanation of their exact contribution to the effort for each Past Performance contract reference. As a reminder, at least one of the contract references submitted must be for work performed by the Prime, JV, or CTA partner, i.e. not a parent company, affiliate, subcontractor etc.
Offeror Response
Experience Discussion Item 1
Describe your experience providing teleradiology services for government, correctional, or detention facilities. What unique challenges did you encounter in these settings, and how did you address them? Additionally, did the contract require an Authority to Operate (ATO)? If so, how was this requirement met?
Offeror Response
Experience Discussion Item 2
Describe your experience managing high volumes of radiology reads across various imaging modalities (e.g., X-ray, CT, MRI, ultrasound) in a remote setting. What strategies, tools, or workflows have you implemented to ensure timely and accurate interpretations under heavy workload conditions? Please specify the volume and complexity of cases handled.
Offeror Response
File details come from the government source that posted it. Updated .