ATTACHMENT 4 PAST PERFORMANCE SURVEY.36C26126Q0203.docx

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Attached to
F108--Modification to Include pricing schedule to be Completed and returned
Solicitation number
36C26126Q0203
Issued by

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This is a Past Performance Survey template for solicitation 36C26126Q0203, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21 for hazardous waste pick-up and disposal services at the VA San Francisco Health Care System. The survey serves as an evaluation tool to assess offeror past performance on relevant contracts.

The survey requires offerors to identify three references and have each reference complete and submit a separate signed survey directly to durell.salaz@va.gov. Each reference must document the services provided, total contract amount, performance dates, and contract number. Evaluators are instructed to rate overall quality of work using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) and provide supporting comments. The survey also requires evaluators to identify any performance issues or concerns and describe how such issues were resolved. Reference provider information is kept confidential and will not be released or made publicly available.

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Disposal Rates Estimate - Hazardous Waste Pick Up and Disposal.xlsx XLSX spreadsheet
36C26126Q0203 0001_1.docx DOCX document
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RFQ 36C26126Q0203.662.Biohazard Waste Management.REVISED.docx DOCX document
ATTACHMENT 3 DOL WAGE DETERMINATION 2015-5651 REV.26, DATED 05-12-2026 - SONOMA.pdf PDF
ATTACHMENT 2 DOL WAGE DETERMINATION 2015-5673 REV.26, DATED 05-13-2026 - DEL NORTE-HUMBOLDT-LAKE-MENDOCINO.pdf PDF
36C26126Q0203_2.docx DOCX document

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Past Performance Survey 36C26126Q0203

OFFEROR INSTRUCTIONS: A separate survey must be completed and signed for each reference. The completed surveys must be submitted directly to durell.salaz@va.gov.

EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the company listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. The name of the individuals providing reference information is confidential and will not be released or made publicly available.

Please Note: When completing this Survey be sure to summarize what service(s) you provided on the contract(s) to include the performance dates, dollar amount(s) and contract number(s).

Name of Company being evaluated:

Evaluator’s Name and signature: Must be signed

Evaluator’s Company Name, Address and Phone number:

Indicate what services did this company provided for you? Provide the total contract amount, dates of performance, and contract number.

Evaluation Questions

Please rate the overall quality of work using a scale of (Excellent, Good, Fair, Marginal, Unacceptable). Comments in support of the rating are welcome.

Were there any performance issues/concerns? If so, how were they handled?

How did the Contractor perform on the contract?

Were there any issues and how did they handle them?

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