Attachment_5_Past_Performance_Reference_Form_FAR_2025.docx
DOCX document 33 KB Posted
- Attached to
- Maxwell RSC 48 DNA Extraction Systems or Equal – Commercial Blanket Purchase Agreement (BPA)
- Solicitation number
- HFP2026133524
About this file
This is a Past Performance Reference Form template for use in responding to a commercial Blanket Purchase Agreement (BPA) solicitation (HFP-2026-133524) issued by the Food and Drug Administration for Maxwell RSC 48 DNA Extraction Systems or equal products. Offerors must submit a minimum of two completed reference forms documenting contracts, purchase orders, BPAs, or projects of similar scope and complexity completed within the previous five years. Each reference form requires documentation of the contract/order number, project title, customer/agency name and address, contract type, period of performance, total contract value, prime contractor or subcontractor status, and current status.
The form evaluates relevance to the requirement across seven evaluation areas: laboratory equipment delivery, installation services, training services, warranty/technical support, multiple delivery locations, federal government customer experience, and commercial product acquisition. Offerors must provide a self-assessment of performance across quality, schedule, management, customer satisfaction, and technical performance using an exceptional-to-unsatisfactory scale. Each reference must include a government customer point of contact with name, title, organization, telephone, and email address, along with authorization for government verification. The form requires offeror certification of accuracy and includes a government-use section for reference verification and past performance rating determination.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 6 Technical Compliance Matrix.docx | DOCX document | |
| Attachment 8 - BPA Solicitation Maxwell.docx | DOCX document | |
| Attachment 4 Buy American Certificate.docx | DOCX document | |
| Attachment 7 - Subcontracting Plan Template.pdf | ||
| Attachment 3 - SF 18 75F40126Q00256 HFP2026133524.pdf | ||
| Attachment 2 - Pricing_Schedule.xlsx | XLSX spreadsheet | |
| Attachment 1 - Performance Work Statement.docx | DOCX document |
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Text version
ATTACHMENT 5 – PAST PERFORMANCE REFERENCE FORM
Solicitation Number: HFP-2026-133524 Maxwell RSC 48 DNA Extraction Systems BPA Offerors shall provide at least two (2) references for contracts, purchase orders, Blanket Purchase Agreements (BPAs), or projects of similar scope and complexity completed within the previous five (5) years. This form supports evaluation of Past Performance in accordance with the solicitation and applicable FAR November 2025 provisions.
Instructions: Complete one form for each reference submitted.
SECTION A – REFERENCE INFORMATION
Reference Contract/Order Number
Project Title
Customer/Agency Name
Customer Address
Contract Type
Period of Performance
Total Contract Value
Prime Contractor/Subcontractor
Current Status (Completed/Ongoing)
Description of Supplies/Services
SECTION B – RELEVANCE TO THIS REQUIREMENT
| Evaluation Area |
| Yes |
| No |
| Explanation |
| Laboratory Equipment Delivery |
| ☐ |
| ☐ |
| Installation Services |
| ☐ |
| ☐ |
| Training Services |
| ☐ |
| ☐ |
| Warranty/Technical Support |
| ☐ |
| ☐ |
| Multiple Delivery Locations |
| ☐ |
| ☐ |
| Federal Government Customer |
| ☐ |
| ☐ |
| Commercial Product Acquisition |
| ☐ |
| ☐ |
SECTION C – CUSTOMER POINT OF CONTACT
Customer Point of Contact Name
Title
Organization
Telephone Number
Email Address
May Government Contact Reference?
☐ Yes ☐ No
SECTION D – PERFORMANCE ASSESSMENT (Offeror Self-Assessment)
| Performance Area |
| Exceptional |
| Very Good |
| Satisfactory |
| Unsatisfactory |
| Quality |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| Schedule |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| Management |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| Customer Satisfaction |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| Technical Performance |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
SECTION E – OFFEROR CERTIFICATION
I certify that the information contained in this Past Performance Reference Form is true, accurate, and complete to the best of my knowledge. I understand the Government may contact the reference identified herein to verify performance information.
Company Name: ________________________________________________
UEI: _________________________________________________________
Authorized Representative: ____________________________________ Title: ________________________________________________________ Signature: ___________________________________________________ Date: ________________________________________________________
SECTION F – GOVERNMENT USE ONLY
Reference Verified: ☐ Yes ☐ No Evaluator: ________________________________________________ Date: _____________________________________________________ Past Performance Rating: ☐ Acceptable ☐ Neutral ☐ Unacceptable Comments: ________________________________________________ 2 | Page
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