D.5 Past Performance Questionnaire updated

The Department of Veterans Affairs, Network Contracting Office 10 is in the process of competitively selecting a source for the NEMT Services program to provide Special Mode Travel services for the organizations.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than 10 December 2026, 1pm EST. This schedule will allow us sufficient time to analyze the data prior to the start of offer evaluations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to [email protected] . Your completed questionnaire will become a part of the official source selection records.

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

Robert J. Bolcavage III
Contracting Specialist

1 Atch

Past Performance Questionnaire

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

Original Schedule (assuming all options exercised):
Current Schedule (assuming all options exercised):
Reason for difference (if applicable):

I. Contract Dollar Value

Original maximum contract dollar value (assuming all options exercised): $ Current maximum contract dollar value (assuming all options exercised): $ Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor☐ Subcontractor☐ Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.