D.6 Past Performance References.pdf

PDF 171 KB Posted

Attached to
Q515--ON-SITE/OFF-SITE Pathology Services/589A7 Federal contract opportunity
Solicitation number
36C25525Q0096_1
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15

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This is a past performance reference template form for RFQ 36C25525Q0096 for On-Site/Off-Site Pathology Services. The form requires offerors to provide three references from organizations where they have provided on-site/off-site pathology services within the last 24 months. For each reference, vendors must include the organization name and address, point of contact details (name, email, phone, title), and a brief description of services provided along with the period of performance.

This template is associated with a VA Medical Center solicitation in Wichita, KS for an IDIQ firm-fixed-price contract spanning one base year (07/01/2025 - 06/30/2026) with four one-year options. The form itself is a standard template that does not contain any completed reference information, only blank fields for offerors to complete.

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D.1 Price Schedule.xlsx XLSX spreadsheet
D.3 Contractor Rules of Behavior.pdf PDF
36C25525Q0096_1.docx DOCX document
D.2 Quality Assurance Surveillance Program QASP.docx DOCX document
D.5 Immigration and Nationality Act.pdf PDF
D.7 Wage Determination 2015-5341 rev 27 7-22-2024.docx.pdf PDF
D.8 BYLAWS Robert J Dole VAMC June 2023.pdf PDF
D.4 Organizational Conflict of Interest.pdf PDF

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PAST PERFORMANCE REFERENCES

Reference Request For Quotation (RFQ) 36C25525Q0096; On-Site/Off-Site Pathology Services

Offerer:_______________________________________________________________________

Provide three (3) references with On-site/Off-site Pathology Services within the last 24 months.

Thank you.

REFERENCE 1 INFORMATION

ORGANIZATION NAME AND

ADDRESS

POINT OF CONTACT

Name:

Email:

Phone:

Title:

BRIEF DESCRIPTION OF SERVICES PROVIDED & PERIOD OF PERFORMANCE

REFERENCE 2 INFORMATION

ORGANIZATION NAME AND

ADDRESS

POINT OF CONTACT

Name:

Email:

Phone:

Title:

BRIEF DESCRIPTION OF SERVICES PROVIDED & PERIOD OF PERFORMANCE

REFERENCE 3 INFORMATION

ORGANIZATION NAME AND

ADDRESS

POINT OF CONTACT

Name:

Email:

Phone:

Title:

BRIEF DESCRIPTION OF SERVICES PROVIDED & PERIOD OF PERFORMANCE

PAST PERFORMANCE REFERENCES

Reference Request For Quotation (RFQ) 36C25525Q0096; On-Site/Off-Site Pathology Services

PAST PERFORMANCE REFERENCES
D.6 Past Performance Questionnaire_PG comments.pdf
PAST PERFORMANCE QUESTIONNAIRE
Offerer:
ORGANIZATION NAME AND ADDRESSRow1_2:
Name_2:
Email_2:
Phone_2:
Title_2:
BRIEF DESCRIPTION OF SERVICES PROVIDED PERIOD OF PERFORMANCERow1_2:
ORGANIZATION NAME AND ADDRESSRow1_3:
Name_3:
Email_3:
Phone_3:
Title_3:
BRIEF DESCRIPTION OF SERVICES PROVIDED PERIOD OF PERFORMANCERow1_3:
ORGANIZATION NAME AND ADDRESSRow1:
Name:
Email:
Phone:
Title:
BRIEF DESCRIPTION OF SERVICES PROVIDED PERIOD OF PERFORMANCERow1:

File details come from the government source that posted it. Updated .