ATTACHMENT F - PAST PERFORMANCE REFERENCES - NX DEFIBRILLATORS.pdf
PDF 154 KB Posted
- Attached to
- 6515--NX Defibrillators
- Solicitation number
- 36C10G25R0012
About this file
ATTACHMENT F is a Past Performance References form for a VA procurement of Defibrillators (Solicitation Number 36C10G25R0012). The document provides a template for offerors to document their prior contract experience relevant to the solicitation, with spaces to detail three separate past performance references. Each reference section requires comprehensive information including contract details, performance period, contract organization, contract type, total awarded price, and a description of work performed. The form includes sections for describing the requirement's relevance to the current solicitation and any performance issues or corrective actions taken. Offerors are expected to demonstrate their capability by providing detailed past performance information that aligns with the VA's requirements for medical defibrillator equipment.
The form is part of a larger solicitation for the Veterans Health Administration's Non-Expendable National Program to purchase Defibrillators for VA Medical Centers nationwide. The procurement seeks four types of defibrillators from a single manufacturer, with a preference for Zoll brand or equivalent products. The contract will be a single award Requirements contract with a 12-month base period and four 12-month option years, using firm-fixed pricing. Offerors must be registered in the System for Award Management (SAM) and provide comprehensive documentation demonstrating their ability to meet the specified technical requirements and past performance standards.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G25R0012 0002.pdf | ||
| 36C10G25R0012 0002_1.docx | DOCX document | |
| Q_A for RFP 36C10G25R0012.pdf | ||
| 36C10G25R0012 0001.pdf | ||
| 36C10G25R0012 0001_1.docx | DOCX document | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX DEFIBRILLATORS.docx | DOCX document | |
| ATTACHMENT E - QUARTERLY SALES REPORT - NX DEFIBRILLATORS.xlsx | XLSX spreadsheet | |
| ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX DEFIBRILLATORS.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ DEFIBRILLATORS.docx | DOCX document | |
| ATTACHMENT B - CONTRACT ADMINISTRATION - NX DEFIBRILLATORS.docx | DOCX document | |
| ATTACHMENT A - PRICE COST SCHEDULE - NX DEFIBRILLATORS.xlsx | XLSX spreadsheet | |
| 36C10G25R0012.docx | DOCX document |
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ATTACHMENT F: PAST PERFORMANCE REFERENCES
No record of relevant or recent past performance Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
Relationship to OFFEROR: OFFEROR PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: 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: 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.
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 PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: 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: YES NO Description of the Requirement: Provide a concise explanation of the work performed, specifically related
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
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
Relationship to OFFEROR: OFFEROR PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: 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: YES NO Description of the Requirement: Provide a concise explanation of the work performed, specifically related
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
| Past Performance Reference 1: |
| OFFEROR NAME: |
| COMPANY who performed this work: |
| OFFEROR: Off |
| PROPOSED SUBCONTRACTOR: Off |
| PRIME: Off |
| SUBCONTRACTOR: Off |
| PRIME SUBCONTRACTORName of Contracting Organization: |
| PRIME SUBCONTRACTORContract Task Order Number for subcontracts provide the prime contract number and the subcontract number: |
| PRIME SUBCONTRACTORContract Type: |
| PRIME SUBCONTRACTORTotal Awarded PriceCost: |
| PRIME SUBCONTRACTORFinal or Projected Final Total PriceCost: |
| PRIME SUBCONTRACTORDelivery datePeriod of performance including base and options if applicable: |
| PRIME SUBCONTRACTORContracting Officers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORProgram Managers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORNorth American Industry Classification System NAICS Code: |
| CPARSPPIRS Completed: |
| undefined: |
| NO: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations 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 CPARSPPIRS report for this reference are to be addressed: |
| OFFEROR NAME_2: |
| COMPANY who performed this work_2: |
| OFFEROR_2: |
| PROPOSED SUBCONTRACTOR_2: |
| undefined_2: |
| PRIME_2: |
| SUBCONTRACTOR_2: |
| Name of Contracting Organization: |
| Contract Task Order Number for subcontracts provide the prime contract number and the subcontract number: |
| Contract Type: |
| Total Awarded PriceCost: |
| Final or Projected Final Total PriceCost: |
| Delivery datePeriod of performance including base and options if applicable: |
| Contracting Officers Name Email and Telephone Number: |
| Program Managers Name Email and Telephone Number: |
| North American Industry Classification System NAICS Code: |
| CPARSPPIRS Completed_2: |
| YES: |
| NO_2: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related_2: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations requirements_2: |
| 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 CPARSPPIRS report for this reference are to be addressed_2: |
| OFFEROR NAME_3: |
| COMPANY who performed this work_3: |
| OFFEROR_3: |
| PROPOSED SUBCONTRACTOR_3: |
| undefined_3: |
| PRIME_3: |
| SUBCONTRACTOR_3: |
| Name of Contracting Organization_2: |
| Contract Task Order Number for subcontracts provide the prime contract number and the subcontract number_2: |
| Contract Type_2: |
| Total Awarded PriceCost_2: |
| Final or Projected Final Total PriceCost_2: |
| Delivery datePeriod of performance including base and options if applicable_2: |
| Contracting Officers Name Email and Telephone Number_2: |
| Program Managers Name Email and Telephone Number_2: |
| North American Industry Classification System NAICS Code_2: |
| CPARSPPIRS Completed_3: |
| YES_2: |
| NO_3: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related_3: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations requirements_3: |
| 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 CPARSPPIRS report for this reference are to be addressed_3: |
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