Attachment 6: Request for Proposals Offeror Past Performance Questionnaire Fillable

895350186181DEPARTMENT OF VETERANS AFFAIRS (VA)

VA’S FY26 ETMPM-TENS Procurement Program Recompete
Solicitation Number 36C79126R0011

Past Performance Questionnaire (PPQs)
Purpose: Offerors to this Solicitation number 36C79126R0011 are required to submit three (3) CPARS Evaluation Reports if available. The Government Evaluators will validate the availability of CPARS Evaluation reports utilizing the Offeror’s System For Award management Unique Entity Identifier for any Offeror that utilizes a PPQ. When an Offeror cannot provide at least three (3) CPARS evaluation reports with effective dates in the past 24 - 36 months, the Offeror shall submit up to three (3) completed PPQs from recent/relevant Customers for similar medical device supply contracts. Note: Any combination of CPARS Evaluation Reports and PPQs shall be utilized to ensure that the Offerors’ proposal submission documentation includes three (3) past performance documents for Government evaluations. This is a material condition of a responsive proposal and may not be waived by the Government.

Instructions For The Rater / Customer (How to complete this PPQ): Please provide information for up to three (3) contracts performed within the last three (3) years that demonstrate the Offeror’s capability to perform the medicaldevice supply work required under Solicitation Number 36C79126R0011. Evaluate the Offeror’s performance as follows:

Scope & Period: Evaluate the Offeror’s performance during the most recent 24–36 months of the referenced contract(s), addressing device quality, delivery timeliness, warranty/RMA support, customerservice responsiveness, labeling and traceability, and regulatory compliance.

Adjectival Ratings: Select one rating for each evaluation area (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, or N/A) and provide narrative evidence supporting each rating. CPARS definitions and standards apply.

Numeric Mapping: Each adjectival rating has a numeric equivalent (5 = Exceptional; 4 = Very Good; 3 = Satisfactory; 2 = Marginal; 1 = Unsatisfactory; N/A = No Score). This mapping assists the VA evaluation team but does not replace qualitative judgment under FAR 15.305 and FAR 15.308.

Narratives Are Mandatory: Every selected rating must include a detailed narrative describing specific performance evidence such as dates, quantities, defect rates, timeliness statistics, corrective actions, and measurable outcomes. Ratings without narratives cannot be used.

Certification & Digital Signature: Please complete the certification block and apply a digital signature. CPARS practice requires documented, signed input from the Rating Official.