The file's text, extracted by GovTribe without its formatting.
Factor 2 - Experience
| (CONTRACTOR NAME) |
| Experience 1 |
| Contract |
| Description of Experience |
| Dollar Amount of Contract |
| Contract Period of Performance |
| Location of Clinic (City, State) |
| VA Clinic (yes or no)? |
| Number of patients at clinic |
| Recent (within three years)? Enter date of contract award |
| Rural or Urban? |
| Types of services offered at clinic |
| Time it took from award to become operational |
| Was mobilization/activation on schedule? If not, why? |
| Self-Performance? If not 100%, what was subcontracted. |
| Were there any performance issues during the period of performance (letters of concern, show cause or cure notices, terminations)? If yes, explain. |
| How did this requirement comply with the PACT model? |
| Experience 2 |
| Contract |
| Description of Experience |
| Dollar Amount of Contract |
| Contract Period of Performance |
| Location of Clinic (City, State) |
| VA Clinic (yes or no)? |
| Number of patients at clinic |
| Recent (within three years)? Enter date of contract award |
| Rural or Urban? |
| Types of services offered at clinic |
| Time it took from award to become operational |
| Was mobilization/activation on schedule? If not, why? |
| Self-Performance? If not 100%, what was subcontracted. |
| Were there any performance issues during the period of performance (letters of concern, show cause or cure notices, terminations)? If yes, explain. |
| How did this requirement comply with the PACT model? |
| Experience 3 |
| Contract |
| Description of Experience |
| Dollar Amount of Contract |
| Contract Period of Performance |
| Location of Clinic (City, State) |
| VA Clinic (yes or no)? |
| Number of patients at clinic |
| Recent (within three years)? Enter date of contract award |
| Rural or Urban? |
| Types of services offered at clinic |
| Time it took from award to become operational |
| Was mobilization/activation on schedule? If not, why? |
| Self-Performance? If not 100%, what was subcontracted. |
| Were there any performance issues during the period of performance (letters of concern, show cause or cure notices, terminations)? If yes, explain. |
| How did this requirement comply with the PACT model? |
| Experience 4 |
| Contract |
| Description of Experience |
| Dollar Amount of Contract |
| Contract Period of Performance |
| Location of Clinic (City, State) |
| VA Clinic (yes or no)? |
| Number of patients at clinic |
| Recent (within three years)? Enter date of contract award |
| Rural or Urban? |
| Types of services offered at clinic |
| Time it took from award to become operational |
| Was mobilization/activation on schedule? If not, why? |
| Self-Performance? If not 100%, what was subcontracted. |
| Were there any performance issues during the period of performance (letters of concern, show cause or cure notices, terminations)? If yes, explain. |
| How did this requirement comply with the PACT model? |
| Experience 5 |
| Contract |
| Description of Experience |
| Dollar Amount of Contract |
| Contract Period of Performance |
| Location of Clinic (City, State) |
| VA Clinic (yes or no)? |
| Number of patients at clinic |
| Recent (within three years)? Enter date of contract award |
| Rural or Urban? |
| Types of services offered at clinic |
| Time it took from award to become operational |
| Was mobilization/activation on schedule? If not, why? |
| Self-Performance? If not 100%, what was subcontracted. |
| Were there any performance issues during the period of performance (letters of concern, show cause or cure notices, terminations)? If yes, explain. |
| How did this requirement comply with the PACT model? |
Factor 3 - Mgmt and Staffing
| MEDICAL STAFFING | | | |
| Name | Position Description (Director, RN, LPN, MD, etc.) | Certification/License (type and State) | Other Qualifications |
| ADMINISTRATIVE STAFFING | | | |
| Name | Position Description | Years of Experience in the Position listed in Column B | Level of Training and/or Experience |
