ATTACHMENT G PAST PERFORMANCE REFERENCE NX EQ HANDS DRILL FOOT CARE.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C10X26Q0093
About this file
This is a Past Performance Reference form template for solicitation 36C10X26Q0093, issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for NX EQ Hand Drills for Foot Care. The document is a blank template that offerors must complete and submit to provide evidence of relevant past performance experience. Responses must be submitted by email to Daleta.Coles@va.gov by May 13, 2026 at 11:59 p.m. EDT. The form notes that there is currently no record of relevant or recent past performance on file.
The template requires offerors to provide three past performance references, with each reference containing specific details including the performing company name, relationship to the offeror (prime or subcontractor), contracting organization, contract or task order number, contract type, awarded price and final cost, delivery dates and period of performance, contracting officer and program manager contact information, NAICS code, and CPARS/PPIRS completion status. For each reference, offerors must provide a concise explanation of work performed and its relevance to the current solicitation requirements, as well as documentation of any performance issues, corrective actions taken, and results. Any issues identified in CPARS/PPIRS reports must be addressed in the performance narrative.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10X26Q0093 0001.docx | DOCX document | |
| ATTACHMENT B CONTRACT ADMINISTRATION NX EQ HANDS DRIL FOOT CARE.docx | DOCX document | |
| ATTACHMENT A PRICE COST SCHEDULE NX EQ NX EQ HANDS DRILL FOOT CARE.xlsx | XLSX spreadsheet | |
| ATTACHMENT D SOLICITATION PROVISIONS NX EQ HANDS DRILL FOOT CARE.docx | DOCX document | |
| ATTACHMENT C Contract Clauses NX EQ HANDS DRILL FOOT CARE.docx | DOCX document | |
| ATTACHMENT F PAST PERFORMANCE QUESTIONNAIRE NX EQ HANDS DRILL FOOT CARE.docx | DOCX document | |
| ATTACHMENT E REPORTING TOOL NX EQ HANDS DRILL FOOT CARE.xlsx | XLSX spreadsheet | |
| 36C10X26Q0093.docx | DOCX document |
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Text version
ATTACHMENT G: PAST PERFORMANCE REFERENCE
NX EQ Hands Drill, Foot Care
SOLICITATION: 36C10X26Q0093
☐ No record of relevant or recent past performance.
Please E-mail to Daleta.Coles@va.gov by, May 13, 2026 at 11:59pm 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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