36C25619Q0948-002.pdf

36C25619Q0948 Annual Inspection of all Radiographic Equipment CAVHS Little Rock, Arkansas Division

Attachment A Relevant Experience Form

Please list your contracts in the chronological order beginning with the most recent one. Contracts listed cannot be more than 5 years old. You can list ongoing contracts that began more than 5 years ago.

Contract #1

1. Customer Name 2. Customer’s Address

3. Name and Title of Contact Point 4. Contact Point’s Email Address

5. Contact Point’s Phone Number 6. Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status ___Ongoing ___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request For Quote documents. Attach separate sheet if additional space is needed.)

Contract #2

1. Customer Name 2. Customer’s Address

3. Name and Title of Contact Point 4. Contact Point’s Email Address

5. Contact Point’s Phone Number 6. Estimated Contract Value

___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request

Contract #3

1. Customer Name 2. Customer’s Address

3. Name and Title of Contact Point 4. Contact Point’s Email Address

5. Contact Point’s Phone Number 6. Estimated Contract Value

___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request