ATTACHMENT F - PAST PERFORMANCE QUESTIONNAIRE - NX EQ Microwave Therapy Systems Tissue Ablation.docx
DOCX document 27 KB Posted
- Attached to
- NX EQ Microwave Therapy Systems: Tissue Ablation Federal contract opportunity
- Solicitation number
- 36C10G25R0048
About this file
This is a Past Performance Questionnaire template for evaluating offerors' previous contract performance under solicitation 36C10G25R0048 for NX EQ Microwave Therapy Systems: Tissue Ablation. The questionnaire is designed to be sent to up to five references from offerors' past three years of contract performance, with completed questionnaires due to Trevor Mason at Trevor.Mason@va.gov by August 7, 2025, at 9:00 AM EST.
The questionnaire evaluates four key performance categories using a three-point rating scale (1-Unsatisfactory, 2-Satisfactory, 3-Excellent): Quality of Service (compliance with contract requirements and technical excellence), Cost Control (effective cost management and accurate invoicing), Timeliness of Performance (meeting milestones and delivery schedules), and Business Relations (contract management and responsiveness to issues). References must provide detailed contract information including contract number, performance period, total contract value, options exercised, and whether any show cause orders, stop work orders, or terminations occurred. The questionnaire also includes space for narrative comments on each performance category and asks whether the reference would choose to work with the offeror again, serving as a comprehensive evaluation tool for the Department of Veterans Affairs Strategic Acquisition Center to assess offeror past performance capabilities.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| RFP_36C10G25R0048.pdf | ||
| ATTACHMENT A - PRICE COST SCHEDULE - NX EQ Microwave Therapy Systems Tissue Ablation.xlsx | XLSX spreadsheet | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ Microwave Therapy Systems Tissue Ablation.pdf | ||
| ATTACHMENT E -QUARTERLY SALES REPORTING TOOL - NX EQ Microwave Therapy Systems Tissue Ablation.xlsx | XLSX spreadsheet | |
| ATTACHMENT G - PAST PERFORMANCE REFERENCE - NX EQ Microwave Therapy Systems Tissue Ablation.docx | DOCX document | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ Microwave Therapy Systems Tissue Ablation.pdf | ||
| ATTACHMENT B - PRODUCT DESCRIPTION - NX EQ Microwave Therapy Systems Tissue Ablation.docx | DOCX document |
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Text version
Attachment F Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0048
DESCRIPTION: NX EQ Microwave Therapy Systems: Tissue Ablation – Varian Medical Systems IntelliBlate™ Microwave Ablation System or Equal
Offerors: 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: Trevor Mason E-MAIL: Trevor.Mason@va.gov
VA SAC is currently in the process of awarding a contract for the solicitation described above. The offeror identified below has provided your organization’s name as a reference under the contract described below:
Offeror Name:
(Insert Offeror’s Name Here)
| Contract Number: |
| (Insert Applicable Contract Number Here) |
Please rate the offeror 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 “Offeror Evaluation.” Please note that the past performance evaluators for this solicitation may contact you for further details in making a fair assessment of this offeror’s past performance. Thank you for your organization’s assistance in fairly evaluating offeror proposals for this solicitation.
Please E-mail Questionnaire to Trevor.Mason@va.gov by 08/07/2025, at 0900 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 Offeror:
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 |
| Offeror is not in compliance and has jeopardized achievement of contract objectives |
| Offeror is unable to manage costs effectively |
| Offeror delays have jeopardized performance |
| Responses to inquiries and issues are not effective |
| 2: Satisfactory |
| Minor inefficiencies and errors have been identified |
| Offeror is usually effective in managing costs |
| Offeror is usually effective in meeting milestones and delivery schedule |
| Responses to inquiries and issues is usually effective |
| 3: Excellent |
| Offeror is in compliance with contract requirements and delivers quality services |
| Offeror is effective in managing costs and submits proper invoices |
| Offeror is effective in meeting and exceeding milestones and delivery schedule |
| Responses to inquiries have been effective and/or exceeded expectations and established deadlines |
Offeror 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 offeror again? |
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