D.3+Reference+Contract+Worksheet Home O2--9.20.22.docx
DOCX document 15 KB Posted
- Attached to
- Q999-- VISN16 Home Oxygen Federal contract opportunity
- Solicitation number
- 36C25622R0128
About this file
This document contains a Reference Contract Worksheet and information about a related federal contract opportunity for home oxygen services. The Reference Contract Worksheet requests information about previous contracts held by offerors for in-home oxygen or ventilator services, including details of services performed, geographic location, dates, number of patients served, whether the offeror was prime contractor or subcontractor, and a reference contact.
The associated federal contract opportunity is being issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 to provide home oxygen services for multiple VA locations within the VISN 16 geographic area, including the Alexandria VA Health Care System in Louisiana, Gulf Coast Veterans Health Center in Mississippi, Michael E. DeBakey VA Medical Center in Texas, Southeast Louisiana Veterans Health Care System in Louisiana, and Overton Brooks VA Medical Center in Louisiana.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25622R0128_3.docx | DOCX document | |
| Copy of Home O2 Price Schedule 5 Station w_Formulas-Updt 10_27_22.xlsx | XLSX spreadsheet | |
| 36C25622R0128 0002.docx | DOCX document | |
| Clarification Questions 36C25622R0128 10_27_2022.docx | DOCX document | |
| 36C25622R0128 0001_1.docx | DOCX document | |
| Amendment-36C25622R0128- 0001.docx | DOCX document | |
| Revised-36C25622R0128 Home O2 - 5 Stations RFP - 09.29.22.docx | DOCX document | |
| 36C25622R0128 Home O2 - 5 Stations RFP - 09.29.22.docx | DOCX document | |
| Copy of Home O2 Price Schedule 9.26.22 w_Formulas.xlsx | XLSX spreadsheet | |
| Sect D BAA.docx | DOCX document | |
| 36C25622R0128_2.docx | DOCX document |
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Text version
Attachment D.3 – Reference Contract Worksheet for Offeror’s Response to Factor 1 – Experience Reference Contract Number ______
The legal name of entity with whom the Offeror held the contract
Contract Number
Whether the contract was for in-home oxygen services, in-home ventilator services or both
A description providing details of the specific tasks the Offeror performed under that Contract
Attachment D.3 – Reference Contract Worksheet for Offeror’s Response to Factor 1 – Experience
Geographic location in which the Offeror performed these services
The dates during which the Offeror performed the contract
| The number of patients to whom the Offeror provided in-home oxygen services or in-home ventilator services, or both, under that contract – break out and specify numbers separately for inhome oxygen services and in-home ventilator services |
| Number of in-home oxygen patients served each month __________ |
Number of in-home ventilator patients served each month __________
Whether the provided reference contract is for services provided by the Offeror or provided by a proposed subcontractor of the Offeror’s
Whether the Offeror or its proposed subcontractor was the prime contractor or a subcontractor for that provided reference contract
The name, phone number, and email address of a person at the entity with whom the Offeror (or Offeror’s proposed subcontractor) held the contract who can verify the information the Offeror provides in the narrative description for this factor
File details come from the government source that posted it. Updated .