Attachment 4 Past Performance References.docx
DOCX document 18 KB Posted
- Attached to
- 6515--Anesthesia Units
- Solicitation number
- 36C24125R0116
About this file
This is a Past Performance References template for solicitation 36C24125R0116, the VA's Request for Proposals for anesthesia units. The template is an unfilled appendix designed for offerors to document their relevant past performance experience and is structured to accommodate three separate past performance references.
The template requires offerors to provide detailed information for each reference, including the company that performed the work, their relationship to the offeror (prime or subcontractor), the contracting organization, contract/task order numbers, contract type, awarded and final prices, delivery dates and periods of performance, contracting officer and program manager contact information, and NAICS codes. For each reference, offerors must include a description of the work performed and its relevance to the solicitation's requirements, as well as an explanation of any performance issues encountered, corrective actions implemented, and results achieved. The template specifically notes that any performance issues documented in CPARS/PPIRS reports must be addressed in the response. This appendix serves as the mechanism for evaluating offeror capability and past experience in delivering anesthesia units, warranty, maintenance, and training services for the national ID/IQ contract being awarded by the Department of Veterans Affairs Veterans Health Administration.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 6 Cross Reference Index.xlsx | XLSX spreadsheet | |
| 36C24125R0116 August 17 FINAL.pdf | ||
| Attachment 3 Updated MTRS June 2026.docx | DOCX document | |
| Attachment 1 VA Directive 6550 Appendix A.pdf | ||
| Attachment 7 Past Performance Questionnaire.docx | DOCX document | |
| Attachment 5 Price_Cost_Schedule_Years_1_to_10.xlsx | XLSX spreadsheet | |
| Attachment 2 mds2 worksheet xlsx.xlsx | XLSX spreadsheet | |
| 36C24125R0116_2.docx | DOCX document |
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Text version
ATTACHMENT 4: PAST PERFORMANCE REFERENCES
VHA Anesthesia Units
SOLICITATION: 36C24125R0116
☐ No record of relevant or recent past performance.
Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 2
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
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