D.7 PAST PERFORMANCE REFERENCES.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25623R0009
About this file
This document contains a past performance reference template and a sources sought notice for onsite emergency department physician services. The template requests information on up to three past performance references, including contract details, dates of performance, point of contact information, and an area for comments. The sources sought notice is from the Department of Veterans Affairs and seeks information from capable service-disabled veteran-owned or veteran-owned small businesses able to provide qualified board-certified or board-eligible emergency medicine physicians 24 hours daily and 7 days weekly onsite at the G.V. (Sonny) Montgomery Veterans Affairs Medical Center in Jackson, Mississippi. Responses are due by March 3, 2023 and should include company information, socio-economic status, capability statements, and estimated pricing. The agency will use market research responses to determine the procurement strategy for a future solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| D.8 PAST PERFORMANCE QUESTIONNAIRE.rtf | RTF text file | |
| D.7 PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| 36C25623R0009 0004.docx | DOCX document | |
| 36C25623R0009_v2.docx | DOCX document | |
| D.12 SMALL BUSINESS SUBCONTRACTING PLAN-CERTIFICATION.pdf | ||
| D.11 INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| D.13 SUBCONTRACTING PLAN MODEL.docx | DOCX document | |
| 36C25623R0009 0003.pdf | ||
| 36C25623R0009 0002.docx | DOCX document | |
| 36C25623R0009 0001.docx | DOCX document | |
| D.1 Quality Assurance Surveillance Plan (QASP)KT signed.pdf | ||
| D.2 SAM.gov User Guide.pdf | ||
| D.5 Organizational Conflict of Interest.docx | DOCX document | |
| D.6 Immigration and Nationality.pdf | ||
| D.4 Medical Staff Bylaws Rules and Regulations Jackson VAMC 3.30.21 (1).pdf | ||
| D.9 INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| D.8 PAST PERFORMANCE QUESTIONNAIRE.rtf | RTF text file | |
| D.10 FREQUENTLY ASKED QUESTIONS.docx | DOCX document | |
| D.3 E-verify Job Aid.pdf | ||
| 36C25623R0009_Final.docx | DOCX document | |
| 36C25623R0009_2.docx | DOCX document |
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Attachment D.9 – Past Performance References
Reference 1:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
Reference 2:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
Reference 3:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
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