S02_D.2 PAST PERFORMANCE CONTRACTS_Revised.pdf

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Cancer Registrar Contract Services
Solicitation number
36C25522Q0114
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Attachment D.2 36C25522Q0114 Offeror: _____________________

Past Performance Survey

Past Performance Survey

Provide a minimum of three current/past performance references below for Cancer and Clinical Registry Services conducted within the past three years, to include the names and phone numbers of responsible individuals who would have firsthand knowledge of the performance. The Government reserves the right to review other past performance records. Records found with unsubstantiated unsatisfactory past performance history may assess the offer as technically unacceptable.

Business Name: _____________________________________________________________

Business Address: ___________________________________________________________

Contact Person: ___________________________ Title: ____________________________

Telephone Number: _________________________ Contract Value: $__________________

Contract Number/Reference: ___________________________________________________

Contract Period of Performance Dates: ___________________________________________

Business Name: _____________________________________________________________

Business Address: ___________________________________________________________

Contact Person: ___________________________ Title: ____________________________

Telephone Number: _________________________ Contract Value: $__________________

Contract Number/Reference: ___________________________________________________

Contract Period of Performance Dates: ___________________________________________

Business Name: _____________________________________________________________

Business Address: ___________________________________________________________

Contact Person: ___________________________ Title: ____________________________

Telephone Number: _________________________ Contract Value: $__________________

Contract Number/Reference: ___________________________________________________

Contract Period of Performance Dates: ___________________________________________

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