Past Performance Survey - 36C24821Q0276.pdf

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S222--FY21: NF/SG Regulated Medical Waste * TIERED EVALUATIONS *
Solicitation number
36C24821Q0276
Issued by

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This document contains a past performance survey template and information about a federal contract opportunity for regulated medical waste pickup and disposal services. The past performance survey is to be completed by references for offerors bidding on Solicitation Number 36C24821Q0276, a requirements contract being issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. The survey requests information on the offeror's past contracts performed for the reference such as total value, dates of performance, and contract numbers. It also contains questions about work quality, performance issues and flexibility in responding to changes. The solicitation is for tiered evaluations for regulated medical waste pickup and disposal services to be provided to the VA on a nationwide basis.

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36C24821Q0276 0001.docx DOCX document
36C24821Q0276_2.docx DOCX document
36C24821Q0276.docx DOCX document
36C24821Q0276.pdf PDF
Compliance with LOS - 36C24821Q0276.pdf PDF

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36C24821Q0276 NF/SG VHS Regulated Medical Waste Services

Past Performance Survey Offeror Name: ________________

OFFEROR INSTRUCTIONS: A separate survey must be completed for each reference. The completed surveys must be included with the offeror’s technical proposal.

EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the Offeror listed above for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive. Under Federal Acquisition Regulation Part 15.506, the name of the individuals providing reference information is confidential and will not be released or made publicly available.

Name of Company being evaluated:

Evaluator’s Name:

Evaluator’s Company Name, Address and Phone number:

What contracts did this offeror perform for your company? Provide the total contract amount, dates of performance, and contract number.

Evaluation Questions Comment on the overall quality of contractor’s work.

Were there any performance issues/concerns? If so, how were they handled?

If any changes were needed, was the contractor flexible in responding to those changes?

Signature Date:

Offeror Name:
Name of Company being evaluated:
Evaluators Name:
Evaluators Company Name Address and Phone number:
What contracts did this offeror perform for your company Provide the total contract amount dates of performance and contract number:
Comment on the overall quality of contractors work:
Were there any performance issuesconcerns If so how were they handled:
If any changes were needed was the contractor flexible in responding to those changes:
Signature:
Date:

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