36C78621Q0089_3.docx

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S208--Past Performance Questionaire Form
Solicitation number
36C78621Q0089
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Contract Opportunity Amendment to a Previous Combined Solicitation

PRODUCT SERVICE CODE

SUBJECT

CONTRACTING OFFICE'S

ZIP-CODE

SOLICITATION NUMBER

BASE NOTICE TYPE

RESPONSE DATE/TIME/ZONE

ARCHIVE

DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS

SET-ASIDE

NAICS CODE

CONTRACTING OFFICE

ADDRESS

POINT OF CONTACT

(POC Information Automatically Filled from User Profile Unless Entered)

DESCRIPTION

See Attachment

AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

ADDRESS

EMAIL DESCRIPTION

ADDRESS

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

GENERAL INFORMATION

PLACE OF PERFORMANCE

* = Required Field Contract Opportunity Amendment to a Previous Combined Solicitation S208 Past Performance Questionaire Form 22172 36C78621Q0089 03-01-2021

10AM

EASTERN TIME, NEW YORK, USA

N

SDVOSBC

561730 Department of Veterans Affairs National Cemetery Administration Contracting Services 18434 Joplin Road Triangle VA 22172 Hugh O'Neil (703)630-9353 Department of Veterans Affairs National Cemetery Administration Cypress National Cemetery 625 Jamaica Ave Brooklyn

NY

11208

USA

Hugh.ONeil@va.gov Contracting Officer

PAST PERFORMANCE QUESTIONAIRE

INSTRUCTIONS: Contractor must identify previous federal, state, local government and or private contracts completed that are similar in size and scope to the contract being evaluated. List at least three (3) contracts for evaluation. Contracts must be either competed or current within the last (5) years. One contract reference per form.

Note: List any National Cemetery Administration (NCA) contracts currently working or previously worked first followed by Non-NCA contracts.

Past Performance Questionnaire

Contract Number

Contractor ( Name Address, Zip Code)

Telephone Number

Email Address

Type of Contract

Contract Dollar Value

Date of Award (if not completed provide status)

Type/Extent of Subcontracting

Percentage of Work completed by the Contractor

Description of Supply/Services provided, location & relevancy of work

Address, Telephone Number & Email of the Contact Person and Position

Form may be duplicated

End of Document

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