D.4_36C24126Q0457_Attach 4_AEEG Past Performance Survey.docx

This is a Past Performance Survey form used to evaluate offerors' qualifications for Solicitation 36C24126Q0457 for Ambulatory Electroencephalogram (aEEG) Technical Services. The form is a template designed to assess the relative risks associated with an offeror's likelihood of success in performing the contract requirements based on their past performance record. Offerors are required to identify and document up to five relevant contracts or service agreements under which they have provided aEEG Technical Services, with evaluation criteria based on recency and relevance to the current solicitation.

The survey captures five line items for past performance examples, with columns for customer identification, contract number, service description, timeframe of service delivery, specific services provided, and relevancy assessment. This evaluation mechanism supports the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 1's efforts to select qualified contractors for this small business set-aside opportunity. The form functions as an appendix to the full solicitation documentation and serves as a key component of the source selection process to determine contractor capability and past performance acceptability criteria.