ATTACHMENT G - PAST PERFORMANCE REFERENCE - NX EQ A-dec Dental Delivery Units and Chairs.docx
DOCX document 25 KB Posted
- Solicitation number
- 36C10G26R0007
About this file
This is a Past Performance Reference template for solicitation 36C10G26R0007 issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for NX EQ A-dec Dental Delivery Units and Chairs. The document serves as an appendix requiring offerors to submit past performance references demonstrating relevant experience with similar dental equipment supply contracts. Offerors must complete three past performance reference sections, with completed submissions due to Kimberly.LeMieux@va.gov by January 19, 2026, at 11:59 a.m. EDT. The solicitation notes there is no record of relevant or recent past performance on file.
Each past performance reference requires offerors to identify whether they performed the work as the prime contractor or subcontractor, provide the contracting organization name, contract/task order numbers, contract type, awarded and final prices, delivery dates and periods of performance, and contact information for the Contracting Officer and Program Manager. Offerors must also include the applicable North American Industry Classification System (NAICS) code and indicate whether a CPARS/PPIRS evaluation was completed. For each reference, offerors must describe the requirement and explain work performed in relation to the solicitation's requirements, and detail any performance issues, corrective actions taken, and results achieved, with particular attention to addressing any issues documented in CPARS/PPIRS reports.
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ATTACHMENT G: PAST PERFORMANCE REFERENCE
NX EQ A-dec Dental Delivery Units and Chairs
SOLICITATION: 36C10G26R0007
☐ No record of relevant or recent past performance.
Please E-mail to Kimberly.LeMieux@va.gov by 01/19/2026, at 11:59am EDT.
Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance(including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 2
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance(including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
| Relationship to Offeror: |
| ☐ OFFEROR ☐ SUBCONTRACTOR |
| Role on the Contract: |
| ☐ PRIME ☐ SUBCONTRACTOR |
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance(including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed:
Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
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