ATTACHMENT F - PAST PERFORMANCE REFERENCE - NX EQ AUTOMATED CARDIAC RESUSCITATORS.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C10X26Q0054
About this file
This is a Past Performance Reference form template for Solicitation 36C10X26Q0054, a Request for Quote (RFQ) issued by the Department of Veterans Affairs for NX EQ Automated Cardiac Resuscitators. The form is designed to collect documentation of an offeror's relevant past performance on three separate reference contracts, with the form noting at the outset that there is no record of relevant or recent past performance available.
For each of the three past performance references, the template requires offerors to provide: the company that performed the work and its relationship to the offeror (prime or subcontractor); the contracting organization and contract/task order number; contract type and awarded pricing (both initial and final); delivery dates and period of performance including any options; contracting officer and program manager contact information; NAICS code; and a detailed description of the work performed and its relevance to the solicitation requirements. Additionally, offerors must explain any performance issues, problems encountered, corrective actions implemented, and the results of those actions, with specific attention to any findings documented in CPARS/PPIRS reports. This is a blank template form awaiting completion by prospective vendors responding to the VA's solicitation for automated cardiac resuscitation equipment.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10X26Q0054.docx | DOCX document | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ AUTOMATED CARDIAC RESUSCITATORS.docx | DOCX document | |
| ATTACHMENT A - PRICE COST SCHEDULE - NX EQ AUTOMATED CARDIAC RESUSCITATORS.xlsx | XLSX spreadsheet | |
| ATTACHMENT G - PAST PERFORMANCE QUESTIONNAIRE - NX EQ AUTOMATED CARDIAC RESUSCITATORS.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ AUTOMATED CARDIAC RESUSCITATORS.docx | DOCX document | |
| ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ AUTOMATED CARDIAC RESUSCITATORS.docx | DOCX document | |
| ATTACHMENT E - REPORTING TOOL - NX EQ AUTOMATED CARDIAC RESUSCITATORS.xlsx | XLSX spreadsheet |
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ATTACHMENT F: PAST PERFORMANCE REFERENCE
NX EQ AUTOMATED CARDIAC RESUSCITATORS
SOLICITATION: 36C10X26Q0054
☐ 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/PPIRS 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/PPIRS 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/PPIRS 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/PPIRS 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/PPIRS 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/PPIRS report for this reference are to be addressed.
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