Attachment 4 Past Performance References.docx
DOCX document 18 KB Posted
- Attached to
- 6515--Anesthesia Units
- Solicitation number
- 36C24125R01160001
About this file
This file is a Past Performance References template for the VA Anesthesia Units solicitation (36C24125R0116). The document provides a standardized format for offerors to submit three past performance references demonstrating relevant experience with anesthesia unit procurement, warranty, maintenance, and training. Each reference section requires offerors to identify whether they performed the work as the prime contractor or subcontractor, provide the contracting organization and contract/task order number, specify contract type and pricing information, document the performance period, and supply contracting officer and program manager contact details. Additionally, offerors must include the NAICS code and confirm whether CPARS/PPIRS reports were completed. The template requires detailed descriptions of work performed with specific relevance to the solicitation's requirements, along with explanations of any performance issues encountered, corrective actions implemented, and results achieved. The document notes that "No record of relevant or recent past performance" should be documented if applicable, and any issues identified in CPARS/PPIRS reports must be addressed in the performance narrative.
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Other files
| File | Type | Posted |
|---|---|---|
| KR question and VA replies to anesthesia RFP.pdf | ||
| D.2 RULES OF BEHAVIOR.pdf | ||
| 36C24125R0116 0001_3.docx | DOCX document | |
| VA_Notice_24-12_Update_to_Handbook_6500_6_22_Apr_24.pdf | ||
| Handbook_6500_24_Feb_2021.pdf | ||
| Amendment 1 SF30.pdf | ||
| CSCA Contractor Security Control Assessment CSCA Department of Veterans Affairs.pdf | ||
| Attachment 6 Cross Reference Index.xlsx | XLSX spreadsheet | |
| Attachment 5 Price_Cost_Schedule_Years_1_to_10.xlsx | XLSX spreadsheet | |
| Attachment 7 Past Performance Questionnaire.docx | DOCX document | |
| 36C24125R0116 August 17 FINAL.pdf | ||
| Attachment 3 Updated MTRS June 2026.docx | DOCX document | |
| Attachment 2 mds2 worksheet xlsx.xlsx | XLSX spreadsheet | |
| Attachment 1 VA Directive 6550 Appendix A.pdf | ||
| 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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