ATTACHMENT 3A - Past Performance Release.docx

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Attached to
Pharmaceutical Repackaging Services for National CMOP (770)
Solicitation number
36C77026R0004
Issued by

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The document is a Past Performance Release form for the Department of Veterans Affairs (VA) related to the Pharmaceutical Repackaging Services for National CMOP (Consolidated Mail Outpatient Pharmacy) solicitation, number 36C77026R0004. The form is designed to obtain consent from a subcontractor or teaming partner to allow the VA Contracting Officer to discuss their past and present performance information with the prime contractor during the source selection process.

The solicitation is being conducted by the VA Veterans Health Administration Veterans Integrated Service Network 15, located in Leavenworth, KS. The specific requirement is for Repacker Services, with the contracting officer being Renee Kreutzer. The form requires the partnering company to provide their company name, address, DUNS number, phone number, and email address, along with an authorized signature to release their performance information for evaluation purposes.

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ATTACHMENT 2 - Bottle Label.pdf PDF
ATTACHMENT 1A - Business Associate Profile Application.pdf PDF
ATTACHMENT 3 - Past Performance Questionnaire.docx DOCX document
S02 RFP 36C77026R0004_Repacking Services_Final_12-10-25.pdf PDF
P09 Performance Work Statement_Repacker_Final.docx DOCX document
ATTACHMENT 2A - Cap Label.pdf PDF
ATTACHMENT 4 - Wage Determination Example.pdf PDF
S02 Pricing Schedule_R0004_Final.xlsx XLSX spreadsheet
ATTACHMENT 1 - Business Associate Agreement.pdf PDF

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RELEASE OF PAST PERFORMANCE

Department of Veterans Affairs Attn: Renee Kreutzer Contracting Officer Network Contracting Office 15 CMOP Acquisitions 3450 S. 4th St. Trafficway Leavenworth, KS 66048 renee.kreutzer@va.gov

We are currently participating as a (subcontractor/teaming partner) with _______________ (prime contractor or name of entity providing proposal) in responding to the Department of Veterans Affairs CMOP Acquisitions request for proposal #36C77025R0006 for the Repacker Services requirement.

We understand that the Government is using past performance as evaluation criteria in order to obtain best value in source selections. In order to facilitate the performance confidence assessment process, we are signing this consent form to allow you to discuss our past and present performance information with the prime contractor during the source selection process, if it becomes necessary.

(Signature and Title of individual who has the authority to sign for and legally bind the partnering company)

Company Name:

Address:

DUNS:

Phone Number:

E-mail Address:

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