ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX EQ ELECTROCARDIOGRAPH.docx
DOCX document 19 KB Posted
- Solicitation number
- 36C10G24R0023
About this file
This document is a Past Performance Questionnaire related to a federal contract opportunity for Electrocardiograph equipment. The Department of Veterans Affairs (VA) is conducting a solicitation, number 36C10G24R0023, to award a single Requirements contract for Electrocardiograph equipment to be used across the VA medical system. The contract will be a Firm-Fixed Price (FFP) Requirements contract with a base period of 12 months and four 12-month option periods. The solicitation is a total set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSBs). Offerors must provide descriptive literature, specifications, and salient characteristics for any "brand name or equal" products they propose, which are detailed in the document. Key requirements include display size, pacemaker detection, gain/sensitivity settings, lead capabilities, data storage, indicators, power supply, and data transmission capabilities. Proposals are due by 11:59 PM EST on May 24, 2024.
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Attachment 6 Past Performance Questionnaire
SOLICITATION NO.: 36C10G24R0023
DESCRIPTION: Electrocardiograph Offerors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of Three References from Past Three Years)
*Past Performance Questionnaires shall be emailed by each reference to Contract Specialist listed below.
DEPARTMENT OF VETERANS AFFAIRS (VA) STRATEGIC ACQUISITION CENTER (SAC) PAST PERFORMANCE QUESTIONNAIRE
TO: Contract Specialist-Lisa Thompson E-MAIL: lisa.thompson10@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 Contract Specialist listed above by close of solicitation.
| 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 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 |
| 0: 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 |
| 1: Poor |
| Major problems have been encountered |
| Offeror has had major difficulty managing costs effectively |
| Offeror has had major difficulty meeting milestones and |
delivery schedule Responses to inquiries and issues are marginally effective
| 2: Fair |
| Some problems have been encountered |
| Offeror is having some problems managing |
costs effectively Offeror is having some problems meeting milestones and delivery schedule Responses to inquiries and issues is somewhat effective
| 3: Good |
| 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
| 4: 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 |
| Category |
| Description |
on Rating Guidelines Above)
| 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: |
Comment from Reference:
| Timeliness of Performance |
| Has met milestones, is reliable, is responsive to technical direction, and has completed milestones on-time or ahead of schedule: |
Comment from Reference:
| 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: |
Comment from Reference:
| YES | NO |
| Overall Satisfaction | |
| Would you (reference) choose to work with this offeror again? |
Comment from Reference:
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