Attachment 6 Past Performance Questionnaire.pdf
PDF 55 KB Posted
- Solicitation number
- 36C26322Q0622
About this file
This document contains a past performance questionnaire template and details of a federal contract opportunity for emergency shelter and related services in Omaha, Nebraska. The past performance questionnaire requests information about two relevant past or present contracts, including contract number, type, buying office contact information, description of work performed, original and final contract values, performance period dates, and space to address any technical concerns.
The federal contract opportunity is solicitation number 36C26322Q0622 to provide emergency shelter and related services for eligible Veteran beneficiaries in support of the VA Nebraska-Western Iowa Health Care System's Health Care for Homeless Veterans program in Omaha, Nebraska. Interested offerors must be able to perform the requirements in the performance work statement starting August 1, 2022 through July 31, 2027. Offerors must submit proposals by 5:00 PM Central Time on June 30, 2022 via email to the contracting officer. Offerors must be registered in SAM and VIP if applicable. The NAICS code is 624221 with a $12 million small business size standard. The contracting office is the VA Network Contracting Office 23 in St. Paul, Minnesota.
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Text version
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 Questionnaire
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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