D.2 ATTACHMENT 2 PAST PERFORMANCE SURVEY.36C26126Q0950.docx
DOCX document 17 KB Posted
- Attached to
- J065--AMD-1 Replace 52. 212-1 Addendum in the Solicitation for Surgical Instrument Sharpening Services
- Solicitation number
- 36C26126Q0950
About this file
This is a Past Performance Survey template for solicitation 36C26126Q0950, a Department of Veterans Affairs procurement for Surgical Instrument Sharpening Services through Veterans Integrated Service Network 21. The survey is designed to be completed by references familiar with the offeror's prior performance and submitted directly to durell.salaz@va.gov.
The survey requests evaluators to document the specific services provided, total contract amounts, performance dates, and contract numbers associated with their experience with the company being evaluated. Evaluators are instructed to rate overall work quality using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) and provide supporting comments. The survey also asks evaluators to identify any performance issues or concerns encountered during contract execution and describe how the contractor addressed them. The instructions note that evaluator identities will remain confidential and will not be released publicly. This is a template document without specific deadline dates, pricing information, or set-aside classifications.
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Other files
| File | Type | Posted |
|---|---|---|
| REVISED 52.212-1 Addendum .docx | DOCX document | |
| 36C26126Q0950 0001_1.docx | DOCX document | |
| D.1 ATTACHMENT 1 DOL WAGE DETERMINATION 2015-5637 REV.32 DATED 05-13-2026 - SAN FRANCISCO-SAN MATEO.pdf | ||
| S02 RFQ 36C26126Q0950.Surgical Instrument Sharpening.pdf | ||
| 36C26126Q0950_1.docx | DOCX document |
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Text version
Past Performance Survey 36C26126Q0950
OFFEROR INSTRUCTIONS: A separate survey must be completed and signed for each reference. The completed surveys must be submitted directly to durell.salaz@va.gov.
EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the company listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. The name of the individuals providing reference information is confidential and will not be released or made publicly available.
Please Note: When completing this Survey be sure to summarize what service(s) you provided on the contract(s) to include the performance dates, dollar amount(s) and contract number(s).
Name of Company being evaluated:
Evaluator’s Name and signature: Must be signed
Evaluator’s Company Name, Address and Phone number:
Indicate what services did this company provided for you? Provide the total contract amount, dates of performance, and contract number.
Evaluation Questions
Please rate the overall quality of work using a scale of (Excellent, Good, Fair, Marginal, Unacceptable). Comments in support of the rating are welcome.
Were there any performance issues/concerns? If so, how were they handled?
How did the Contractor perform on the contract?
Were there any issues and how did they handle them?
File details come from the government source that posted it. Updated .