Attachment 6 Past Performance Reference Form.docx
DOCX document 33 KB Posted
- Attached to
- Maxwell RSC 48 DNA Extraction Systems or Equal – Commercial Blanket Purchase Agreement (BPA)
- Solicitation number
- HFP-2026-133524-75F40126Q00256
About this file
This is a Past Performance Reference Form template designed for vendors responding to the FDA's solicitation for Maxwell RSC 48 DNA Extraction Systems or Equal under Solicitation Number HFP-2026-133524-75F40126Q00256. The form serves as an appendix to the solicitation and does not specify required products, services, pricing terms, or response dates. Rather, it functions as a standardized template that prospective contractors must complete to demonstrate their relevant experience and qualifications in providing similar equipment, installation, training, and support services to federal laboratory facilities or comparable organizations.
As a template document, the Past Performance Reference Form establishes the format and information requirements that offerors must follow when submitting their past performance credentials. This requirement aligns with the FDA's evaluation criteria for the commercial blanket purchase agreement (BPA) for laboratory instrumentation, where vendors must evidence prior successful delivery and support of comparable DNA extraction systems or analytical laboratory equipment. The form is part of the broader combined synopsis/solicitation issued by the Department of Health and Human Services Food and Drug Administration through its Office of Acquisitions and Grants Services.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachmen 5 Buy American Certificate.docx | DOCX document | |
| Attachment 4 - SF18.pdf | ||
| Attachment 7 Technical Compliance Matrix.docx | DOCX document | |
| Attachment 1 - BPA Solicitation Maxwell .docx | DOCX document | |
| Attachment 2 - PWS.docx | DOCX document | |
| Attachment 3 - Pricing_Schedule.xlsx | XLSX spreadsheet |
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Text version
ATTACHMENT 6 – 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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