D.2 ATTACHMENT 2 PAST PERFORMANCE SURVEY.36C26127Q0050.docx

This is a Past Performance Survey template for solicitation 36C26127Q0050, which is a VA contract opportunity for Medical Delivery Services of Opioid Treatment Medications at Residential and Treatment Facilities for the VASFHCS (VA San Francisco Health Care System), managed by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.

The survey is designed to be completed by offerors and submitted separately for each reference directly to durell.salaz@va.gov. Evaluators completing the form must provide their name, signature, company name, address, and phone number. The survey requires evaluators to document the specific services provided by the company being evaluated, including performance dates, dollar amounts, and contract numbers. The evaluation section requests assessments of overall quality of work using a five-point scale (Excellent, Good, Fair, Marginal, Unacceptable) with supporting comments, identification of any performance issues or concerns and how they were resolved, and a general assessment of contractor performance including documentation of issues and remediation approaches. The template does not specify response dates, pricing terms, or other solicitation-specific details, as it is a reference evaluation instrument rather than a substantive solicitation document.