36C25719Q1296-011.docx

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Male-Only HCHV Services Federal contract opportunity
Solicitation number
36C25719Q1296
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17

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36C25719Q1296 D1 - PAST PERFORMANCE INFORMATION.docx

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PAST PERFORMANCE INFORMATION (PPI) FORM

(TO BE COMPLETED BY OFFEROR FOR EACH REFERENCE PROVIDED)

Contract Number:

Contractor (Name and Address):

Type of Contract: Negotiated______ Sealed Bid_______ Fixed Price__________ Cost Reimbursement______ Hybrid (explain)_______________

Complexity of Work: Difficult__________ Routine__________

Description, location, and relevancy of work. Describe a program where a significant problem or problems developed, explaining the origins of the problem(s) and HOW the problem was detected and resolved. Alternatively, if no such situation exists present a situation where a problem was avoided:

Contract Dollar Value: ___________________________ Status: Active_____________ Completed ___________

Date of Award:_________________ Contract Completion Date (including extensions):_____________________

Type and Extent of Subcontracting (please note limitations on subcontracting allowed under FAR 52.219-14):

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