ATTACHMENT F - PAST PERFORMANCE REFERENCES - NX EQ EEG SYSTEMS.pdf

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Attached to
NX EQ Monitors_Physio_Neurology_Intraop_EEG (VA-26-00045643)
Solicitation number
36C10X26R0062
Issued by

About this file

Written by GovTribe AI ·

This is a past performance reference form template used for federal contract proposals. The attachment provides a standardized format for offerors to document three past performance references that demonstrate relevant experience and capability to perform the proposed work.

The form captures essential contract details including the offeror name, performing company, relationship to the offeror (whether the offeror is the prime contractor or proposed subcontractor), work role (prime or subcontractor), contracting organization name, contract/task order number, contract type, total awarded price, final/projected final price, delivery dates and period of performance, contracting officer contact information, program manager contact information, and North American Industry Classification System (NAICS) code. For each reference, the template requires a concise description of the work performed with specific relevance to the solicitation requirements, and a detailed explanation of any performance issues or problems that occurred during execution, including corrective actions taken and results achieved. The form also includes a checkbox to indicate whether a CPARS/PPIRS (Contractor Performance Assessment Reporting System/Past Performance Information Retrieval System) report was completed for the reference. An optional checkbox at the beginning allows offerors to indicate "No record of relevant or recent past performance" if applicable. The template accommodates up to three past performance references and is designed to support evaluation of contractor capability and prior performance history.

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Other files

File Type Posted
36C10X26R0062_2.pdf PDF
SF30 36C10X26R0062 0002.pdf PDF
36C10X26R0062.pdf PDF
36C10X26R0062_1.docx DOCX document
SF30 36C10X26R0062 0001.pdf PDF
36C10X26R0062 Vendor Questions.pdf PDF
ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ EEG SYSTEMS.docx DOCX document
852.219-76 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING-CERTIFICATE OF COMPLIANCE FOR SUPPLIES AND PRODUCTS -DEVIATION.docx DOCX document
ATTACHMENT A - PRICE COST SCHEDULE - NX EQ EEG SYSTEMS.xlsx XLSX spreadsheet
ATTACHMENT H - RFQ QUESTIONS - NX EQ EEG SYSTEMS.xlsx XLSX spreadsheet
APPENDIX C - NX EQ EEG SYSTEMS.docx DOCX document
ATTACHMENT J - CERTIFICATION OF RECALL OR SAFETY ISSUES - NX EQ EEG SYSTEMS.docx DOCX document
ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX EQ EEG SYSTEMS.docx DOCX document
ATTACHMENT E - QUARTERLY SALES REPORT - NX EQ EEG SYSTEMS.xlsx XLSX spreadsheet
ATTACHMENT C - CONTRACT CLAUSES - NX EQ EEG SYSTEMS.docx DOCX document
ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ EEG SYSTEMS.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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