36C25718Q0370-003.docx

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Internet and TV Cable Services at Temple, Waco and Austin TX VA Medical Facilities
Solicitation number
36C25718Q0370
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36C25718Q0370 Attachment A - Corporate Experience Form.docx

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CORPORATE EXPERIENCE FORM

Please list your contracts in the chronological order beginning with the most recent one. Contracts listed should 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 Point of Contact
4.Point of Contact’s Email Address
5.Point of Contact’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 Solicitation documents. Attach separate sheet if additional space is needed.)

36C25718Q0370 Cable Based Television and Internet Services - CTX

Contract #2

1.Customer Name
2. Customer’s Address
3.Name and Title of Point of Contact
4.Point of Contact’s Email Address
5.Point of Contact’s Phone Number
6.Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

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

Contract #3

1.Customer Name
2. Customer’s Address
3.Name and Title of Point of Contact
4.Point of Contact’s Email Address
5.Point of Contact’s Phone Number
6.Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

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

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