ATTACHMENT F - PAST PERFORMANCE QUESTIONAIRE - NX EQ Lasers ND YAG SLT Ophthalmic.docx
DOCX document 20 KB Posted
- Attached to
- 6515--NX EQ Surgical Lasers
- Solicitation number
- 36C10G24Q0116
About this file
This document is a Past Performance Questionnaire related to a federal contract solicitation for ELLEXA brand name or equal Lasers: ND: YAG+SLT: Ophthalmic. The solicitation, number 36C10G24Q0116, is being issued by the Department of Veterans Affairs (VA) Strategic Acquisition Center (SAC) as a single award requirements contract. The Lasers: ND: YAG+SLT: Ophthalmic are used for various surgical procedures across multiple medical specialties. The solicitation has a one-year base period with four one-year option periods. Quotes are due by May 28, 2024. The Past Performance Questionnaire requests information from references on the Quoter's quality of service, cost control, timeliness of performance, and business relations. Respondents are asked to rate the Quoter's performance and indicate if they would work with the Quoter again.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT E REPORTING TOOL NX EQ Lasers ND YAG SLT Ophthalmic.xlsx | XLSX spreadsheet | |
| ATTACHMENT D - SOLICITATION PROVISIONS NX EQ Lasers ND YAG SLT Ophthalmic.docx | DOCX document | |
| ATTACHMENT B - CONTRACT ADMINISTRATION NX EQ Lasers ND YAG SLT Ophthalmic.docx | DOCX document | |
| 36C10G24Q0116.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES NX EQ Lasers ND YAG SLT Ophthalmic.docx | DOCX document | |
| ATTACHMENT G - PAST PERFORMANCE REFERENCE - NX EQ Lasers ND YAG SLT Ophthalmic.docx | DOCX document | |
| ATTACHMENT A PRICE COST SCHEDULE NX EQ Lasers ND YAG SLT Ophthalmic 02.xlsx | XLSX spreadsheet |
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Attachment F Past Performance Questionnaire
SOLICITATION NO.: 36C10G24Q0116
DESCRIPTION: NX EQ Lasers: ND: YAG+SLT: Ophthalmic– ELLEX® Brand Name or Equal
Quoters: Please Send to Each Reference Cited in Submitted Proposal (Maximum of Five References from Past Three Years)
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
| TO: Contract Specialist, Alex Beck | Contracting Officer, Sara Vickroy | |
| E-MAIL: Alex.Beck1@va.gov | sara.vickroy@va.gov |
VA SAC is currently in the process of awarding a contract for the solicitation described above. The Quoter identified below has provided your organization’s name as a reference under the contract described below:
Quoter Name:
(Insert Quoter’s Name Here)
| Contract Number: |
| (Insert Applicable Contract Number Here) |
Please rate the Quoter in each of the categories on this questionnaire. See “Rating Guidelines” section for detailed description of categories and ratings. There is room for comments where you deem remarks would be helpful to our evaluation (see ‘Comment from Reference’ under “Quoter Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this Quoter’s past performance. Thank you for your organization’s assistance in fairly evaluating Quoter proposals for this solicitation.
Please E-mail Questionnaire to Alex.Beck1@va.gov by May 28, 2024, at 11:59 PM EST._
| Name of Reference: |
| (Reference Complete These Sections) |
Title of Reference:
Phone Number:
E-Mail Address:
Name of Organization:
Contract Period of Performance (Month/Day/Year Begin and End):
Total Contract Value (Base and All Option Years):
Options Exercised on Contract (Yes/No)?
Brief Description of Services/Commodity Provided by Quoter:
Show Cause Order Issued on Contract (Yes/No)?
Stop Work Order Issued on Contract (Yes/No)?
Termination for Convenience, Cause, or Default Issued on Contract (Yes/No)?
Rating Guidelines:
| Rating |
| Quality of Service |
| Cost Control |
| Timeliness of Performance |
| Business Relations |
| 1: Unsatisfactory |
| Quoter is not in compliance and has jeopardized achievement of contract objectives |
| Quoter is unable to manage costs effectively |
| Quoter delays have jeopardized performance |
| Responses to inquiries and issues are not effective |
| 2: Satisfactory |
| Minor inefficiencies and errors have been identified |
| Quoter is usually effective in managing costs |
| Quoter is usually effective in meeting milestones and delivery schedule |
| Responses to inquiries and issues is usually effective |
| 3: Excellent |
| Quoter is in compliance with contract requirements and delivers quality services |
| Quoter is effective in managing costs and submits proper invoices |
| Quoter is effective in meeting and exceeding milestones and delivery schedule |
| Responses to inquiries have been effective and/or exceeded expectations and established deadlines |
Quoter Evaluation:
| Rating (List Number Based on Rating Guidelines Above) |
| Category |
| Description |
| Quality of Service |
| In compliance with contract requirements, submits accurate reports/deliverables, has effective personnel, and has achieved/maintained technical excellence: |
Comment from Reference: _______________________
| Cost Control |
| Has achieved efficiencies in costs, managed costs effectively, and has submitted timely/accurate invoices with supporting documentation: |
| Timeliness of Performance |
| Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule: |
| Business Relations |
| Has maintained effective management of contract, has exhibited reasonable/cooperative behavior, is responsive to contract requirements, is responsive to inquiries/issues, and is proactive about resolving problems: |
| |_| YES |_| NO |
| Overall Satisfaction |
| Would you (reference) choose to work with this Quoter again? |
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