ATTACHMENT G - PAST PERFORMANCE QUESTIONAIRE - NX EQ STERILIZATION UNITS STEAM.docx
DOCX document 24 KB Posted
- Solicitation number
- 36C10G25R0030
About this file
This is a Past Performance Questionnaire template designed for the Department of Veterans Affairs (VA) Strategic Acquisition Center (SAC) to evaluate offerors competing for Solicitation No. 36C10G25R0030, which concerns NX EQ Sterilization Units (Steam) branded as Steris or equal products. The questionnaire must be completed by references cited in submitted proposals, with a maximum of five references from the past three years. Completed questionnaires should be emailed to Lisa Thompson at Lisa.thompson10@va.gov by May 1, 2026, at 11:59 PM EST.
The questionnaire evaluates offerors across four primary performance categories: Quality of Service, Cost Control, Timeliness of Performance, and Business Relations. Each category uses a three-point rating scale (1 = Unsatisfactory, 2 = Satisfactory, 3 = Excellent), with specific performance criteria defined for each level. References provide ratings and comments for each category, and indicate whether a Show Cause Order, Stop Work Order, or Termination for Convenience, Cause, or Default was issued on the contract. The questionnaire also includes an Overall Satisfaction question asking if the reference would choose to work with the offeror again. References must supply their contact information, organization name, contract period of performance, total contract value, and a brief description of services or commodities provided by the offeror.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT H - RFP QUESTIONS - NX EQ STERILIZATION UNITS STEAM.xlsx | XLSX spreadsheet | |
| ATTACHMENT E - REPORTING TOOL - NX EQ STERILIZATION UNITS STEAM.xlsx | XLSX spreadsheet | |
| ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ STEILIZATION UNITS STEAM.docx | DOCX document | |
| ATTACHMENT F - PAST PERFORMANCE REFERENCE NX EQ STERILIZATION UNITS STEAM.docx | DOCX document | |
| ATTACHMENT C - CONTRACT CLAUSES - NX EQ STERILIZATION UNITS STEAM.docx | DOCX document | |
| ATTACHMENT A - PRICE LISTS - Steam Sterilization Units.xlsx | XLSX spreadsheet | |
| ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ STERILIZATION UNITS STEAM.docx | DOCX document | |
| 36C10G25R0030.docx | DOCX document |
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Text version
36C10G25R0030
Attachment G Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0030
DESCRIPTION: NX EQ STERILIZATION UNITS STEAM – Steris 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: 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 Lisa.thompson10@va.gov by May 1, 2026, at 11:59 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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