Attachment 6 Past Performance.pdf
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- Solicitation number
- 36C26322Q0878
About this file
This document includes a past performance questionnaire template and details of a federal contract opportunity solicitation for magnetic resonance imaging (MRI) and related medical services. The past performance questionnaire requests information about two relevant past or present contracts, including contract details, value, period of performance, and technical areas of concern.
The solicitation is for MRI and related services in Lincoln and Grand Island, Nebraska for eligible Veteran beneficiaries of the VA Nebraska-Western Iowa Health Care System. Interested service-disabled veteran-owned small businesses must provide both MRI equipment and services starting October 1st, 2022. Proposals are due by September 6th, 2022 and must be submitted electronically to the specified contracting officer. The solicitation is set aside for eligible SDVOSBs, who must directly perform at least 50% of the requirement. The NAICS code is 621512 with a small business size standard of $16.5 million. The agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23.
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PRESENT AND PAST PERFORMANCE QUESTIONNAIRE
A. PLEASE PROVIDE TWO (2) PAST AND/OR PRESENT PERFORMANCE REFERENCES FOR THE MOST
RECENT, RELEVANT CONTRACTS. PLEASE RETURN THIS PACKAGE WITH YOUR
BID/PROPOSAL/QUOTATION.
OFFEROR’S/BIDDER’S NAME (Company/Division): _________________________________________________
JOB 1
1. CONTRACT NUMBER: ________________________________ 2. TYPE: ____________________________
3. BUYING OFFICE:
a. Address: _________________________________________________________________________________
b. Phone: __________________________________________________________________________________
c. Contracting Officer/Point of Contact: __________________________________________________________
4. BRIEF DESCRIPTION OF EFFORT: ____________________________________________________________
5. CONTRACT $ VALUE: a. Original: _________________________________________________________
b. Value at Completion: _______________________________________________
c. Reason for any Change: _____________________________________________
6. PERFORMANCE PERIOD: a. Date Completed/To Be Completed: ____________________________________
b. Reason for Any Change: ____________________________________________
7. USE THIS SPACE TO ADDRESS ANY TECHNICAL (OR OTHER) AREA OF CONCERN CONSIDERED
UNIQUE: _____________________________________________________________________________________
Attachment 6: Past Performance
OFFEROR’S/BIDDER’S NAME (Company/Division): _________________________________________________
JOB 2
1. CONTRACT NUMBER: ________________________________ 2. TYPE: ____________________________
3. BUYING OFFICE:
a. Address: _________________________________________________________________________________
b. Phone: ___________________________________________________________________________________
c. Contracting Officer/Point of Contact: ___________________________________________________________
4. BRIEF DESCRIPTION OF EFFORT: ____________________________________________________________
5. CONTRACT $ VALUE: a. Original: _________________________________________________________
b. Value at Completion: _______________________________________________
c. Reason for any Change: _____________________________________________
6. PERFORMANCE PERIOD: a. Date Completed/To Be Completed: ____________________________________
b. Reason for Any Change: ____________________________________________
7. USE THIS SPACE TO ADDRESS ANY TECHNICAL (OR OTHER) AREA OF CONCERN CONSIDERED
UNIQUE: _____________________________________________________________________________________
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