ATTACHMENT H_PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 33 KB Posted
- Solicitation number
- 36C10G25R0046
About this file
This document is a Past Performance Questionnaire for VA Solicitation No. 36C10G25R0046 related to the GE MUSE Data Management System. The questionnaire is designed for references to evaluate an offeror's performance across four key categories: Quality of Service, Cost Control, Timeliness of Performance, and Business Relations. Each category can be rated from 1 (Unsatisfactory) to 3 (Excellent), with space for detailed comments and an overall recommendation on whether the reference would work with the offeror again.
The associated federal contract opportunity is a sole source Firm Fixed Price award to TrillaMed, LLC, a Service-Disabled Veteran-Owned Small Business, for procuring the GE MUSE Electrocardiographs (ECG) Data Management System. The system is critical for 170+ VHA facilities, storing millions of veteran ECG records with comprehensive historical data tracking. The contract leverages NAICS code 339112 with a size standard of 1,000 employees, focusing on the unique capabilities of the GE MUSE system in providing comprehensive access to historical ECG data and clinical change detection tools essential for cardiovascular monitoring.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G25R0046 0001.docx | DOCX document | |
| RFP 36C10G25R0046_GE MUSE ECG Data Management System.pdf | ||
| ATTACHMENT F_CERTIFICATION OF RECALL OR SAFETY ISSUES.docx | DOCX document | |
| ATTACHMENT E_JUSTIFICATION AND APPROVAL FOR OTHER THAN FULL AND OPEN COMPETITION.pdf | ||
| ATTACHMENT I_DRAFT BUSINESS ASSOCIATE AGREEMENT.docx | DOCX document | |
| ATTACHMENT B_PRODUCT DESCRIPTION.docx | DOCX document | |
| ATTACHMENT D_PRICE COST SCHEDULE.xlsx | XLSX spreadsheet | |
| ATTACHMENT G_PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| ATTACHMENT C_CONTRACT SECURITY HANDBOOK 6500_6_APPENDIX C.pdf | ||
| ATTACHMENT A_ QUARTERLY SALES REPORTING TOOL.xlsx | XLSX spreadsheet | |
| 36C10G25R0046.docx | DOCX document |
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SOLICITATION NO.: 36C10G25R0046
DESCRIPTION: GE MUSE Data Management System
Attachment H Past Performance Questionnaire
SOLICITATION NO.: 36C10G25R0046
DESCRIPTION: GE MUSE Data Management System
Offerors: Please Send to Each Reference Cited in Submitted Proposal (Maximum of 3 References from Past Three Years)
DEPARTMENT OF VETERANS AFFAIRS (VA)
STRATEGIC ACQUISITION CENTER (SAC)
PAST PERFORMANCE QUESTIONNAIRE
E-MAIL completed form to: Anthony.Zibolski@va.gov, ensuring that the email subject line includes “36C10G25R0046”
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.
| 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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