Past Performance Survey_36C26126Q0778.pdf
PDF 36 KB Posted
- Attached to
- Boiler Safety Device Testing
- Solicitation number
- 36C26126Q0778
About this file
This document is a Past Performance Reference Survey used by the Department of Veterans Affairs to evaluate contractor performance for Solicitation No. 36C26126Q0778, which concerns Boiler Safety Device Testing Services. The survey must be completed and returned to karen.cooper332@va.gov no later than 20 July 2026 at 4:00 PM Eastern Time.
The survey requests reference information including the name, title, organization, phone number, and email address of the person providing the evaluation. Respondents must provide details about the contract or project being referenced, including its name or number, period of performance, approximate dollar value, and a brief description of services performed. The survey includes checkboxes to identify whether the work involved boiler safety device testing, pressure vessel inspection support, central energy plant inspection/testing services, Boiler External Inspection (BEI) safety device testing, testing or inspection in accordance with VHA Directive 1810 or similar requirements, hospital or healthcare facility work, or other similar work. The performance evaluation section consists of seven questions assessing the contractor's overall quality of performance, timeliness of work completion and documentation, qualification of personnel, coordination of site access and safety requirements, identification and reporting of deficiencies, performance issues or concerns, and recommendation for future similar work. Each question provides multiple response options and space for detailed comments, with responses to be signed and dated by the reference.
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Other files
| File | Type | Posted |
|---|---|---|
| Amend 0002 Att 2_Performance Work Statement - Updated.docx | DOCX document | |
| Amend 0002 Att 1_Questions and Answers.docx | DOCX document | |
| 36C26126Q0778 0002.docx | DOCX document | |
| 36C26126Q0778 0001 - Amendment 0001.pdf | ||
| 36C26126Q0778_Boiler Safety Device Testing.docx | DOCX document | |
| PWS ATTACHMENT A - Equipment and Safety Device Inventory.docx | DOCX document | |
| PWS ATTACHMENT C - Quality Assurance Surveillance Plan.docx | DOCX document | |
| 36C26126Q0778_Combined Synopsis.docx | DOCX document | |
| PWS ATTACHMENT B - Government-Provided Testing Forms and Checklists.docx | DOCX document | |
| WD 2015-5609 Rev 29 dated 05-13-2026.pdf |
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Text version
Past Performance Reference Survey Boiler Safety Device Testing Services | Solicitation No. 36C26126Q0778
Past Performance Reference Survey - Boiler Safety Device Testing Services | Page 1
The Department of Veterans Affairs is evaluating past performance for the company listed below. Your response will assist the Government in evaluating the company's record of performing work similar in scope, magnitude, and complexity to the current requirement.
Please complete and return this survey to karen.cooper332@va.gov no later than 20 July 2026 at 4:00 PM Eastern Time.
Company Being Evaluated
Company Name:
Reference Information
Reference Name/Title: Organization:
Phone Number: Email Address:
Contract / Project Information
Contract/Project Name or Number:
Period of Performance: Approximate Dollar Value:
Briefly describe the services performed by the company:
Did the work include any of the following? Check all that apply.
Boiler safety device testing
Pressure vessel inspection support
Central energy plant inspection/testing services
Boiler External Inspection (BEI) safety device testing
Testing or inspection in accordance with VHA Directive 1810 or similar requirements
Hospital, healthcare facility, or mission-critical facility work
Other similar work:
Past Performance Reference Survey Performance Questions
Past Performance Reference Survey - Boiler Safety Device Testing Services | Page 2
Performance Questions
1. How would you rate the company's overall quality of performance?
Excellent Good Satisfactory Marginal Unsatisfactory N/A or Unknown
Comments:
2. Did the company complete the required work and documentation on time?
Yes No N/A or Unknown
Comments:
3. Did the company provide qualified personnel capable of performing the required work?
Yes No N/A or Unknown
Comments:
4. Did the company properly coordinate site access, outages, shutdowns, safety requirements, and work activities?
Yes No N/A or Unknown
Comments:
5. Did the company identify, document, and report deficiencies or concerns when required?
Yes No N/A or Unknown
Comments:
6. Were there any performance issues or concerns?
Yes No
Comments:
7. Would you recommend this company for similar work in the future?
Yes No Maybe
Comments:
Reference Signature: Date:
| company_name: |
| ref_name_title: |
| ref_org: |
| ref_phone: |
| ref_email: |
| contract_project: |
| period: |
| dollar_value: |
| services_description: |
| work_boiler_testing: Off |
| work_pressure_vessel: Off |
| work_central_energy: Off |
| work_bei: Off |
| work_vha1810: Off |
| work_healthcare: Off |
| work_other: |
| q1_quality_1_excellent: Off |
| q1_quality_2_good: Off |
| q1_quality_3_satisfactory: Off |
| q1_quality_4_marginal: Off |
| q1_quality_5_unsatisfacto: Off |
| q1_quality_6_n_a_or_unkno: Off |
| q1_quality_comments: |
| q2_timely_1_yes: Off |
| q2_timely_2_no: Off |
| q2_timely_3_n_a_or_unkno: Off |
| q2_timely_comments: |
| q3_qualified_1_yes: Off |
| q3_qualified_2_no: Off |
| q3_qualified_3_n_a_or_unkno: Off |
| q3_qualified_comments: |
| q4_coordination_1_yes: Off |
| q4_coordination_2_no: Off |
| q4_coordination_3_n_a_or_unkno: Off |
| q4_coordination_comments: |
| q5_deficiencies_1_yes: Off |
| q5_deficiencies_2_no: Off |
| q5_deficiencies_3_n_a_or_unkno: Off |
| q5_deficiencies_comments: |
| q6_issues_1_yes: Off |
| q6_issues_2_no: Off |
| q6_issues_comments: |
| q7_recommend_1_yes: Off |
| q7_recommend_2_no: Off |
| q7_recommend_3_maybe: Off |
| q7_recommend_comments: |
| signature: |
| signature_date: |
File details come from the government source that posted it. Updated .