Past Performance Survey.docx

DOCX document 14 KB Posted

Attached to
J041--Ventilation System Verification Testing and Balancing Federal contract opportunity
Solicitation number
36C26126Q0242
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

About this file

The provided document is a Past Performance Survey form for a Department of Veterans Affairs (VA) contract evaluation. The survey is designed to collect reference information about a company's performance, with evaluators asked to rate overall work quality on a scale from Excellent to Unacceptable and provide details about past contracts, including total contract amount, performance dates, and contract numbers. Evaluators are requested to email the completed survey to Emily.Trinh@va.gov by January 6, 2026 at 12:00 PM PST.

The related federal contract opportunity (Solicitation Number 36C26126Q0242) is for ventilation system verification testing and balancing services at the San Francisco VA Health Care System. The solicitation is specifically set aside for Service Disabled Veteran Owned Small Businesses (SDVOSB), with NAICS code 238220. Contractors must be registered in SAM.gov to be eligible, and are advised to carefully review the solicitation's instructions to ensure quote compliance. The opportunity is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21.

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Text version

Past Performance Survey

OFFEROR INSTRUCTIONS: A separate survey must be completed for each reference. The completed surveys must be included with the quote.

EVALUATOR INSTRUCTIONS: The Department of Veterans Affairs is considering the company listed below for award of a VA contract. Your comments would be appreciated regarding this company’s past performance. The name of the individuals providing reference information is confidential and will not be released or made publicly available.

Email signed survey to Emily.Trinh@va.gov no later than January 6, 2026 12:00PM PST.

Name of Company being evaluated:

Evaluator’s Name and signature:

Evaluator’s Company Name, Address and Phone number:

Indicate what contracts did this company provide for you? Provide the total contract amount, dates of performance, and contract number.

Evaluation Questions

Please rate the overall quality of work using a scale of (Excellent, Good, Fair, Marginal, Unacceptable). Comments in support of the rating are welcome.

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

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