36C10G20R0014-036.docx

ATTACHMENT 7: PAST PERFORMANCE REFERENCES

☐ No record of relevant or recent Past Performance

Past Performance Reference #1

OFFEROR NAME:

COMPANY who performed this work:

Relationship to OFFEROR :

☐Offeror ☐ Proposed Major Subcontractor

WORK PERFORMED AS THE:

☐Prime ☐ Proposed Major Subcontractor

Name of Contracting Organization:

Name of Project:

Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):

Contract Type:

Total Awarded Price/Cost:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer's Name, Email, and Telephone Number:

Program Manager's Name, Email, and

Telephone Number:

North American Industry Classification System (NAICS) Code:

CPARS Completed:

☐Yes ☐ No

Description of the Requirement: Provide detailed written explanation/description of the work performed, specifically related to how it is relevant to this solicitation’s requirements in both size and complexity as outlined in the Instructions to Offerors. Provide a detailed written description (size) Size shall detail if the reference meets or exceeds $100,000,000 in healthcare, dental and/or pharmacy claims paid within a 12-month period or if the healthcare serves were provided in a geographic coverage area and population density less than 50 persons per square mile for the healthcare, dental and/or pharmacy network. Complexity shall detail as to whether if the reference includes payment of healthcare claims in accordance with Medicare payment rules, transmission of healthcare claims using a clearinghouse, return of medical documentation and building a rural network.

Performance: Provided a detailed explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.

☐ No record of relevant or recent Past Performance

Past Performance Reference #2

OFFEROR NAME:

COMPANY who performed this work:

Relationship to OFFEROR :

☐Offeror ☐ Proposed Major Subcontractor

WORK PERFORMED AS THE:

☐Prime ☐ Proposed Major Subcontractor

Name of Contracting Organization:

Name of Project:

Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):

Contract Type:

Total Awarded Price/Cost:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer's Name, Email, and Telephone Number:

Program Manager's

Telephone Number:

North American Industry Classification System (NAICS) Code:

CPARS Completed:

☐Yes ☐ No

Description of the Requirement: Provide detailed written explanation/description of the work performed, specifically related to how it is relevant to this solicitation’s requirements in both size and complexity as outlined in the Instructions to Offerors. Provide a detailed written description (size) Size shall detail if the reference meets or exceeds $100,000,000 in healthcare, dental and/or pharmacy claims paid within a 12-month period or if the healthcare serves were provided in a geographic coverage area and population density less than 50 persons per square mile for the healthcare, dental and/or pharmacy network. Complexity shall detail as to whether if the reference includes payment of healthcare claims in accordance with Medicare payment rules, transmission of healthcare claims using a clearinghouse, return of medical documentation and building a rural network.

Performance: Provided a detailed explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.

☐ No record of relevant or recent Past Performance

Past Performance Reference #2

OFFEROR NAME:

COMPANY who performed this work:

Relationship to OFFEROR :

☐Offeror ☐ Proposed Major Subcontractor

WORK PERFORMED AS THE:

☐Prime ☐ Propose Major Subcontractor

Name of Contracting Organization:

Name of Project:

Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):

Contract Type:

Total Awarded Price/Cost:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer's Name, Email, and Telephone Number:

Program Manager's

Telephone Number:

North American Industry Classification System (NAICS) Code:

CPARS Completed:

☐Yes ☐ No

Description of the Requirement: Provide detailed written explanation/description of the work performed, specifically related to how it is relevant to this solicitation’s requirements in both size and complexity as outlined in the Instructions to Offerors. Provide a detailed written description (size) Size shall detail if the reference meets or exceeds $100,000,000 in healthcare, dental and/or pharmacy claims paid within a 12-month period or if the healthcare serves were provided in a geographic coverage area and population density less than 50 persons per square mile for the healthcare, dental and/or pharmacy network. Complexity shall detail as to whether if the reference includes payment of healthcare claims in accordance with Medicare payment rules, transmission of healthcare claims using a clearinghouse, return of medical documentation and building a rural network.

Performance: Provided a detailed explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.

☐ No record of relevant or recent Past Performance

Past Performance Reference #4

OFFEROR NAME:

COMPANY who performed this work:

Relationship to OFFEROR :

☐Offeror ☐ Proposed Major Subcontractor

WORK PERFORMED AS THE:

☐Prime ☐ Propose Major Subcontractor

Name of Contracting Organization:

Name of Project:

Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):

Contract Type:

Total Awarded Price/Cost:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer's Name, Email, and Telephone Number:

Program Manager's

Telephone Number:

North American Industry Classification System (NAICS) Code:

CPARS Completed:

☐Yes ☐ No

Description of the Requirement: Provide detailed written explanation/description of the work performed, specifically related to how it is relevant to this solicitation’s requirements in both size and complexity as outlined in the Instructions to Offerors. Provide a detailed written description (size) Size shall detail if the reference meets or exceeds $100,000,000 in healthcare, dental and/or pharmacy claims paid within a 12-month period or if the healthcare serves were provided in a geographic coverage area and population density less than 50 persons per square mile for the healthcare, dental and/or pharmacy network. Complexity shall detail as to whether if the reference includes payment of healthcare claims in accordance with Medicare payment rules, transmission of healthcare claims using a clearinghouse, return of medical documentation and building a rural network.

Performance: Provided a detailed explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.

☐ No record of relevant or recent Past Performance

Past Performance Reference #5

OFFEROR NAME:

COMPANY who performed this work:

Relationship to OFFEROR :

☐Offeror ☐ Proposed Major Subcontractor

WORK PERFORMED AS THE:

☐Prime ☐ Propose Major Subcontractor

Name of Contracting Organization:

Name of Project:

Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):

Contract Type:

Total Awarded Price/Cost:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer's Name, Email, and Telephone Number:

Program Manager's

Telephone Number:

North American Industry Classification System (NAICS) Code:

CPARS Completed:

☐Yes ☐ No

Description of the Requirement: Provide detailed written explanation/description of the work performed, specifically related to how it is relevant to this solicitation’s requirements in both size and complexity as outlined in the Instructions to Offerors. Provide a detailed written description (size) Size shall detail if the reference meets or exceeds $100,000,000 in healthcare, dental and/or pharmacy claims paid within a 12-month period or if the healthcare serves were provided in a geographic coverage area and population density less than 50 persons per square mile for the healthcare, dental and/or pharmacy network. Complexity shall detail as to whether if the reference includes payment of healthcare claims in accordance with Medicare payment rules, transmission of healthcare claims using a clearinghouse, return of medical documentation and building a rural network.

Performance: Provided a detailed explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS report for this reference are to be addressed.