Attachment E_Past Performance References_NX EQ Irrigation Systems for Endoscopy.docx
DOCX document 31 KB Posted
- Solicitation number
- 36C10X26R0030
About this file
This is a Past Performance Reference form template for solicitation 36C10X26R0030, a Request for Proposal issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for NX EQ Irrigation Systems for Endoscopy. The document is designed to collect relevant past performance information from offerors and includes space for three separate past performance references.
The template requires offerors to provide detailed information for each reference, including the company that performed the work, the relationship to the offeror (prime or subcontractor), the contracting organization, contract/task order number, contract type, total awarded and final prices, delivery dates and periods of performance, contracting officer and program manager contact information, and NAICS codes. For each reference, offerors must provide a concise explanation of work performed and its relevance to the solicitation requirements, as well as a description of any performance issues or problems that occurred, corrective actions taken, and results achieved. The form notes that any issues documented in CPARS reports must be addressed in the performance section. The document as presented contains no completed entries, indicating this is a blank template for offerors to complete as part of their proposal response.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10X26R0030 0001.docx | DOCX document | |
| Attachment G_Template for Industry Questions_NX EQ Irrigation Systems for Endoscopy.xlsx | XLSX spreadsheet | |
| Attachment B_Product Description_NX EQ Irrigation Systems for Endoscopy.docx | DOCX document | |
| 36C10X26R0030_1.docx | DOCX document | |
| Attachment H_Certification of Recall or Safety Issue_NX EQ Irrigation Systems for Endoscopy.docx | DOCX document | |
| Attachment D_Price Cost Schedule_NX EQ Irrigation Systems for Endoscopy.xlsx | XLSX spreadsheet | |
| Attachment A_RFP 36C10X26R0030_NX EQ Irrigation Systems for Endoscopy.docx | DOCX document | |
| Attachment C_Sales Reporting Tool_NX EQ Irrigation Systems for Endoscopy.xlsx | XLSX spreadsheet | |
| Attachment F_Past Performance Questionnaire_NX EQ Irrigation Systems for Endoscopy.docx | DOCX document |
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Text version
ATTACHMENT E: PAST PERFORMANCE REFERENCE
IRRIGATION SYSTEMS FOR ENDOSCOPY
SOLICITATION: 36C10X26R0030
☐ No record of relevant or recent past performance.
Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.
Past Performance Reference # 2
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.
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