S02 Past Performance Questionnaire.docx

19 KB Posted

Attached to
Q301--36C259-26-AP-1918 | Prostate Testing Non-Invasive | VISN Contract
Solicitation number
36C25926Q0515
Issued by

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Written by GovTribe AI ·

This is a Past Performance Questionnaire template for a Request for Quote (RFQ) solicitation. The document is designed to collect information from offerors regarding their relevant past performance experience as part of their proposal submission for the VA VISN 19 Prostate Cancer Testing (Non-Invasive) Blanket Purchase Agreement. Offerors must complete this questionnaire to demonstrate their qualifications and track record in delivering similar medical laboratory services. The questionnaire serves as an evaluation criterion and allows the Government to assess contractor capability, reliability, and quality of work on comparable projects. Completion of this form is mandatory as part of the overall RFQ response, which is due by 8:00 AM MT on September 2, 2026, with submission required via email only to Alejandra.Sierra@va.gov and NCO19Lab@va.gov. The Government will evaluate past performance information in conjunction with pricing and other proposal elements to make award decisions for this firm-fixed-price contract under the Department of Veterans Affairs Veterans Integrated Service Network 19 (VISN 19).

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36C25926Q0515 0001.docx DOCX document
Attached Line-Item Schedule.xlsx XLSX spreadsheet
36C25926Q0515.docx DOCX document
BPA Terms.docx DOCX document
SOW Prostate Cancer Testing Non-Invasive.docx DOCX document

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Past Performance Questionnaire Instructions:

1. Complete all sections of the questionnaire.

2. Ensure all contact information is accurate and up-to-date.

3. Have the contractor send a signed and completed questionnaire to the contracting officer or designated point of contact by the quote deadline.

1. Name of contractor being reviewed:

2. Description of Services Performed:

· Please provide a detailed description of the services performed under this contract. Include any specific objectives, scope of work, and notable achievements or challenges encountered.

· Prime contractor? Yes or no

· Complexity: ☐ HIGH ☐MEDIUM ☐LOW

3. Performance Dates:

· Start Date (MM/DD/YYYY):

· End Date (MM/DD/YYYY):

4. Total Contract Value:

· Please provide the total value of the contract (in USD):

5. Addresses:

Organization Name:

Street Address:

City:

State:

ZIP Code:

6. Contract Numbers:

· Contract Number:

· Task Order Number (if applicable):

7. Point of Contact Information:

· Name:

· Title:

· Phone Number:

· Email Address:

8. Performance Rating:

· Please rate the overall performance of the contractor according to the following criteria:

· Outstanding: Performance significantly exceeded expectations in all essential areas and accomplished goals that were not anticipated.

· Satisfactory: Performance met expectations and contract requirements.

· Unsatisfactory: Performance did not meet expectations and contract requirements.

· Please check the appropriate rating:

· ☐ Outstanding

· ☐ Satisfactory

· ☐ Unsatisfactory

· Additional Comments (if rated other than satisfactory): Lengthy explanation or justification for the given rating, including examples of the contractor's strengths or areas for improvement:

Verification:

· The information provided above is accurate and complete to the best of my knowledge. I authorize the verification of the services performed as described.

Signature: Please sign as indicated below Name:_________________________ Title:___________________________ Date:__________________________

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