ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX DEFIBRILLATORS.docx
DOCX document 23 KB Posted
- Attached to
- 6515--NX Defibrillators
- Solicitation number
- 36C10G25R0012
About this file
This document is a Past Performance Questionnaire for a federal solicitation (36C10G25R0012) seeking Zoll Defibrillators or equal products for the Veterans Health Administration (VHA). The solicitation is for a single award Requirements contract to purchase four types of defibrillators: a Critical Care Transport Monitor/Defibrillator, a Crash-cart ALS defibrillator, a Crash-cart Automated External Defibrillator (AED), and a Public access AED. The contract will have a 12-month base period with four 12-month option years, with firm-fixed price delivery orders placed against the contract.
The past performance questionnaire is designed for references to evaluate the offeror's performance across four key categories: Quality of Service, Cost Control, Timeliness of Performance, and Business Relations. References are asked to rate the offeror on a scale of 1-3 and provide comments. The questionnaire must be completed and submitted via email to Courtney Chattman and Jessica Edwards by May 26, 2025, at 16:30 CST. Offerors are limited to submitting a maximum of five references from the past three years, and the VA reserves the right to contact references for further details in evaluating proposals.
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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 E - QUARTERLY SALES REPORT - NX DEFIBRILLATORS.xlsx | XLSX spreadsheet | |
| 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 | |
| ATTACHMENT F - PAST PERFORMANCE REFERENCES - NX DEFIBRILLATORS.pdf | ||
| ATTACHMENT D - SOLICITATION PROVISIONS - NX DEFIBRILLATORS.docx | DOCX document |
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36C10G25R0012 Attachment G Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0012
DESCRIPTION: NX Zoll® Defibrillators Brand Name 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: Courtney Chattman and Jessica Edwards E-MAIL: Courtney.Chattman@va.gov and Jessica.Edwards6@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 Courtney.Chattman@va.gov and Jessica.Edwards6@va.gov no later than May 26, 2025, at 16:30 CST.
| 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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