10 Past Performance List of References Franklin County OH 36C10F25R0057.pdf

This is a Past Performance List of References form for a Veterans Affairs (VA) lease solicitation. The document is a template requiring offerors to submit past performance references in support of their proposal for RLP No. 36C10F25R0057, a lease opportunity for an Outpatient Primary Care (OPC) facility located in Franklin County, Ohio. The offer submission deadline is January 11, 2027, at 5:00 PM ET. The VA Lease Contracting Officer is Anntwinette Dupree-Hart (anntwinette.dupree-hart@va.gov), and the VA Brokers are Patricia Restrepo and Thomas Leahy at Chartwell Enterprises.

The form requires offerors to provide up to five past performance contract references with detailed information including the contract reference number, contractor entity name, Unique Entity Identifier (UEI) number, past performance reference contact name/title, phone, and email. For each reference, offerors must indicate whether they are referencing a VA contract using a previously completed Past Performance Questionnaire (PPQ) (Option A), a VA contract where a PPQ request was submitted to the reference with submission date (Option B), or a non-VA contract (Option C). The form includes blank fields for the offering entity's legal name and provides space for the lessor and government to sign.