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, which is an RFP for anesthesia units issued by the Department of Veterans Affairs Veterans Health Administration. The template indicates that no record of relevant or recent past performance was found at the time of document creation. The form provides a structured format for offerors to document up to three past performance references, whether performed as a prime contractor or subcontractor.
The template requires offerors to provide comprehensive details for each reference, including the contracting organization, contract or task order number, contract type, total awarded and final/projected costs, delivery dates and performance periods, and contact information for both the Contracting Officer and Program Manager. Additionally, offerors must include the relevant NAICS code and indicate whether a CPARS/PPIRS evaluation was completed. For each reference, offerors must provide a detailed description of the work performed and its relevance to the solicitation's requirements, along with an explanation of any performance issues that occurred, corrective actions implemented, and the results achieved. The form explicitly requires that any issues identified in CPARS/PPIRS reports be addressed in the performance narrative.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 3 Updated MTRS June 2026.docx | DOCX document | |
| Attachment 7 Past Performance Questionnaire.docx | DOCX document | |
| Attachment 6 Cross Reference Index.xlsx | XLSX spreadsheet | |
| Attachment 5 Price_Cost_Schedule_Years_1_to_10.xlsx | XLSX spreadsheet | |
| Attachment 1 VA Directive 6550 Appendix A.pdf | ||
| 36C24125R0116_2.docx | DOCX document | |
| Attachment 2 mds2 worksheet xlsx.xlsx | XLSX spreadsheet | |
| 36C24125R0116 August 17 FINAL.pdf |
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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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