ATTACHMENT E_PAST PERFORMANCE REFERENCES_NX EQ Laparoscopic Insufflators.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C10X26R0009
About this file
This is a Past Performance References template form for Solicitation 36C10X26R0009, a Request for Proposal issued by the Department of Veterans Affairs for NX EQ Laparoscopic Insufflators. The form indicates that the offeror has no record of relevant or recent past performance, which triggers the requirement to provide three past performance references to demonstrate capability and experience.
The template provides three blank reference sections, each requesting detailed information including the company that performed the work, its relationship to the offeror (prime or subcontractor), contracting organization, contract or task order number, contract type, total awarded price, delivery dates or periods of performance, contracting officer and program manager contact information, NAICS code, and a description of the requirement and performance. Offerors must explain how each reference is relevant to the solicitation's requirements and address any performance issues, corrective actions taken, and results achieved. The form requires certification of CPARS completion for each reference. This is an appendix template designed to support offerors in documenting their qualifications for this SDVOSB set-aside acquisition of new OEM laparoscopic insufflators for the VA.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT G_Template for Industry Questions_A0001.xlsx | XLSX spreadsheet | |
| ATTACHMENT A_RFP 36C10X26R0009 A0001_NX EQ Laparoscopic Insufflators.pdf | ||
| 36C10X26R0009_2.docx | DOCX document | |
| ATTACHMENT H_CERTIFICATION OF RECALL OR SAFETY ISSUES.docx | DOCX document | |
| ATTACHMENT B PD NX EQ Laparoscopic Insufflators.pdf | ||
| 36C10X26R0009.docx | DOCX document | |
| ATTACHMENT G_Template for Industry Questions.xlsx | XLSX spreadsheet | |
| ATTACHMENT C_SALES REPORTING TOOL_NX EQ Laparoscopic Insufflators.xlsx | XLSX spreadsheet | |
| ATTACHMENT F_PAST PERFORMANCE QUESTIONNAIRE_NX EQ Laparoscopic Insufflators.docx | DOCX document | |
| ATTACHMENT D_PRICE COST SCHEDULE_NX EQ Laparoscopic Insufflators.xlsx | XLSX spreadsheet | |
| ATTACHMENT A_RFP 36C10X26R0009_NX EQ Laparoscopic Insufflators.pdf |
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Text version
ATTACHMENT E: PAST PERFORMANCE REFERENCES
Laparoscopic Insufflators
SOLICITATION: 36C10X26R0009
☐ 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: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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: |
| ☐ Yes ☐ No |
Description of the Requirement: [Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.]
[Description of Requirement Continued]
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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