ATTACHMENT G - Past Performance Questionnaire - NX EQ TRANSPORT VENTILATORS.docx
DOCX document 22 KB Posted
- Attached to
- 6515--NX EQ Transport Ventilators
- Solicitation number
- 36C10G25R0004
About this file
This document is a Past Performance Questionnaire related to a federal contract opportunity for NX EQ Transport Ventilators, Solicitation No. 36C10G25R0004, issued by the Department of Veterans Affairs (VA) Strategic Acquisition Center (SAC).
The solicitation is for a single award Requirements contract to purchase Transport Ventilators for use by VA medical centers nationwide. The contract will have a 12-month base period with four 12-month option years. The solicitation is a brand name or equal commercial item procurement, with the Hamilton T1A Transport Ventilator as the brand name item. Offerors must indicate if they are proposing an equal product and provide details on the salient characteristics. Proposals are due by November 1, 2024. The Past Performance Questionnaire is to be completed by references provided by offerors and returned to the VA by November 1, 2024. This acquisition is set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB).
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT F - Past Performance References - NX EQ TRANSPORT VENTILATORS.docx | DOCX document | |
| ATTACHMENT C - Contract Clauses - NX EQ TRANSPORT VENTILATORS.docx | DOCX document | |
| ATTACHMENT D - Solicitation Provisions - NX EQ TRANSPORT VENTILATORS.docx | DOCX document | |
| ATTACHMENT B - Contract Administration - NX EQ TRANSPORT VENTILATORS.docx | DOCX document | |
| ATTACHMENT E - Reporting Tool - NX EQ TRANSPORT VENTILATORS.xlsx | XLSX spreadsheet | |
| 36C10G25R0004.docx | DOCX document | |
| ATTACHMENT A - Price Cost Schedule - NX EQ TRANSPORT VENTILATORS.xlsx | XLSX spreadsheet |
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36C10G25R0004 NX EQ Transport Ventilators
Attachment G Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0004
DESCRIPTION: Hamilton T1® Transport Ventilator or Equal Brand Name
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 November 1, 2024, at noon 12:00 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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