ATTACHMENT C PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

Solicitation Number: 36C24827Q0036Acquisition ID#: 36C248-26-AP-2908Requirement: Remove/Install Two (2) Commercial-Grade Laser/LED ProjectorsIssuing Agency: U.S. Department of Veterans Affairs, Network Contracting Office 8 (NCO 8)Place of Performance: Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL 32827

INSTRUCTIONS

To the Offeror
Complete Section A – Offeror Information and Section B – Reference Contract Information below. Provide this questionnaire to the customer point of contact (POC) identified by you as past performance reference. Request that the POC complete Sections C through G and return the completed questionnaire directly to the VA Contracting Officer by the date identified in the solicitation. Do not submit this questionnaire yourself after it has been completed by the reference. Questionnaires received from the offeror rather than directly from the reference will not be considered. A minimum of two (2) and a maximum of three (3) completed questionnaires should be returned on your behalf. To Past Performance Reference (Customer POC)
The offeror identified in Section A below has submitted a quotation to the U.S. Department of Veterans Affairs for a commercial audiovisual projector replacement and installation project. The VA is evaluating the offeror's past performance as part of the award decision. Please complete Sections C through G based on your direct experience with the offeror on the reference contract identified in Section B. Return the completed questionnaire directly to the VA Contracting Officer at the email address below by the date identified in the solicitation. Do not return the completed questionnaire to the offeror. Your responses will be used solely for the evaluation of this specific acquisition and will be protected from disclosure to the maximum extent permitted by law under FAR 42.1103. The questionnaire should take approximately 10–15 minutes to complete. If you have questions, contact the VA Contracting Officer at the information below. Return Completed Questionnaire To
Rohan McKenzie, Contracting OfficerNetwork Contracting Office 8 (NCO 8)Department of Veterans AffairsEmail: [email protected] Subject Line: Past Performance Questionnaire – 36C24827Q0036 – [Offeror Name] Completed questionnaires must be received by: [Response Date] at 1:00 PM Eastern Time

SECTION A – OFFEROR INFORMATION (Completed by Offeror)
Field
Entry
Offeror Legal Name

DBA (if applicable)