ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX EQ Infusion Pumps Multitherapy Ambulatory.docx
DOCX document 24 KB Posted
- Solicitation number
- 36C10G25Q0081
About this file
This document is a Past Performance Questionnaire for a VA Strategic Acquisition Center solicitation (36C10G25Q0081) seeking ICU Medical Brand Name or Equal Infusion Pumps for Multitherapy Ambulatory use. The solicitation is a Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside for purchasing infusion pumps to be used across VA Medical Centers, with a base 12-month contract and four 12-month option periods. The procurement covers 13 specific contract line items (CLINs) for CADD-Solis ambulatory infusion pumps and related accessories, including pumps in various colors and configurations, mounting adapters, batteries, communication modules, and power adapters.
Key solicitation details include a quote submission deadline of June 16, 2025, at 11:59 PM EST, with questions due by June 9, 2025. The pumps must meet specific salient characteristics, including FDA clearance, pole mountability, patient-controlled analgesia mode, weight under 0.6 kg, and audio alarm volume control. The VA requires vendors to provide descriptive literature demonstrating product compliance, with the government reserving the right to award without discussions. The procurement is classified under NAICS code 339112 for Surgical and Medical Instrument Manufacturing, with a size standard of 800 employees, and will be awarded as a single requirements contract with firm-fixed pricing and FOB destination delivery.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G25Q0081 0004.docx | DOCX document | |
| 36C10G25Q0081 0003.docx | DOCX document | |
| 36C10G25Q0081 0002.docx | DOCX document | |
| 36C10G25Q0081 0001.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ Infusion Pumps Multitherapy Ambulatory.docx | DOCX document | |
| ATTACHMENT E - REPORTING TOOL NX EQ Infusion Pumps Multitherapy Ambulatory.xlsx | XLSX spreadsheet | |
| ATTACHMENT A - PRICE COST SCHEDULE - NX EQ Infusion Pumps Multitherapy Ambulatory.xlsx | XLSX spreadsheet | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ Infusion Pumps Multitherapy Ambulatory.docx | DOCX document | |
| ATTACHMENT F - PAST PERFORMANCE REFERENCE - NX EQ Infusion Pumps Multitherapy Ambulatory.docx | DOCX document | |
| ATTACHMENT B - CONTRACT ADMINISTRATION -NX EQ Infusion Pumps Multitherapy Ambulatory.docx | DOCX document | |
| 36C10G25Q0081_1.docx | DOCX document |
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36C10G25Q0081 NX EQ Infusion Pumps Multitherapy Ambulatory Attachment G Past Performance Questionnaire
SOLICITATION NO.: 36C10G25Q0081
DESCRIPTION: ICU Medical ® Brand Name or Equal Infusion Pumps Multitherapy Ambulatory
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: Kimberly LeMieux E-MAIL: Kimberly.LeMieux@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 Kimberly.LeMieux@va.gov no later than June 12, 2025, at 16:30 PM EST.
| 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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