VA244-17-R-1154-007.docx

ATTACHMENT 6

SAMPLE QUESTIONNAIRE COVER LETTER

CORPORATE LETTERHEAD

(Date)

FOR OFFICIAL USE ONLY

The VA Pittsburgh Healthcare System (VAPHS) is in the process of selecting a contractor to provide Neurophysiology Services to the VAPHS. The solicitation requires the Contractor to furnish all personnel to provide services necessary to perform onsite Surgical Neurophysiologist Physician Services and Neurodiagnostic Technologist to eligible beneficiaries of the Department of Veterans Affairs Medical Center, University Drive, Pittsburgh, PA 15240.

One of the considerations in the proposal evaluation is the verification of our past/present performance on contracts that are similar in size and scope to the VAPHS procurement. The VAPHS is depending on information received from agencies/businesses such as yours, which have had first- hand experience with our efforts.

The areas of interest are summarized in the enclosed questionnaire. The VAPHS appreciates your response no later than **fill in due date**. This schedule will allow the evaluation team time to analyze the data.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out and emailed to the Contracting specialist, Brandi Shellhammer, at brandi.shellhammer@va.gov. Your completed questionnaire will become a part of the official Source Selection records.

Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Signature

1 Attachment: Questionnaire