D.7 PAST PERFORMANCE REFERENCES.docx
DOCX document 16 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, points of contact, and comments. The sources sought notice is to identify potential sources for providing qualified emergency physicians 24 hours daily and 7 days weekly 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 services required include board certified or eligible physicians in internal medicine, family medicine, or emergency medicine with an unrestricted medical license, VA emergency department experience, EHR and EDIS system knowledge, and coverage for day, evening, night, weekend, and holiday shifts.
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Other files
| File | Type | Posted |
|---|---|---|
| D.8 PAST PERFORMANCE QUESTIONNAIRE.rtf | RTF text file | |
| 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.7 PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| 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.7 – 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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