36C25618Q9727-015.docx

DOCX document 15 KB Posted Nov 13, 2018

Attached to: Lithotripsy Services
Solicitation number: 36C25618Q9727
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17

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36C25618Q9727 Copy of PAST PERFORMANCE.docx

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D.2 PAST PERFORMANCE WORKSHEET

1. Name of Contracting Activity, Government Agency, Commerical Firm or other Organization:

2. Contracting Activity Address:

3. Contract Number:

4. Date of Contract Award:

5. Beginning Date of Contract:

6. Completion Date of Contract:

7. Contract Value:

8. Type of Contract:

9a. Technical Point of Contact:

Name:

Title:

Address:

Telephone:

Email:

9b. Contracting Point of Contact:

Name:

Title:

Address:

Telephone:

Email:

10. Place of Performance:

11. Description of Work (Use a continuation sheet if necessary):

12. List any commendations or awards received:

13. List of Major Subcontractors:

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