4-RFP Past Present FILLABLE.pdf

138 KB Posted

Attached to
Worker's Compensation and NYSGML 207c Claims Administration
Solicitation number
RFP-RC-2025-022
Issued by
Rockland County, New York

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Written by GovTribe AI ·

This document is a Past & Present Performance Information Form for Rockland County, New York, specifically for RFP-RC-2025-022 for Worker's Compensation and NYSGML 207C Claims Administration. The form is designed to be completed by potential offerors to provide detailed information about their previous contract performance as part of a technical proposal submission.

The form requires comprehensive details about past contracts, including the name of the contracting entity, contract name/title, term of contract, original and current contract values, and a description of the effort. Offerors must specify whether they were a prime or subcontractor, provide original and final contract dates, note any change orders, and list primary customer points of contact. Additional sections require information about subcontractors used and key individuals who participated in the contract and are proposed to support the current acquisition.

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Other files

File Type Posted
8-Addendum 2.pdf PDF
1-Appendix B Standard Terms Conditions for Service Contracts.pdf PDF
2-RFP-RC-2025-022 Workers Comp Final .pdf PDF
7-Addendum 1.pdf PDF
5-PMA 2020 03504 Final.pdf PDF
9-Addendum 3.pdf PDF
3-RFP Statement of Disclosures.pdf PDF
6-FEDERAL CONTRACT CLAUSE FILLABLE.pdf PDF

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Edwin J. Day, County Executive

PAST & PRESENT PERFORMANCE INFORMATION FORM

COMPLETE AND INCLUDE THIS FORM IN YOUR TECHNICAL PROPOSAL

NAME OF OFFEROR: __________________________________

Provide the information requested on this form for each contract/program being described as a reference. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the number of past efforts submitted and the length of each submission to the limitations, if any, set forth in specifications.

Name of Contracting Entity: ___________________________________ Contract Name/Title: __________________________________

Term of Contract: ____________________________

Original Contract Value: ________________________________ Current or Final Contract Value: _______________________________________

A. Brief Description of your effort. Identify whether you were a Prime or Subcontractor.

1. Original Date: ______________________________ 2. Current or Final Date: __________________________

3. Number of Change Orders (if any): ________________

Primary Causes or Reasons of Change: ________________________________________________________________________

B. Primary Customer Points of Contact:

NOTE: CONFIRM CONTACT INFORMATION PROVIDED IS CURRENT PRIOR TO SUBMISSION.

Reference Program/Project Manager:

Name:______________________________________________________

Address:____________________________________________________

Telephone: ______________________ Fax: _______________________

E-mail: _____________________________________________________

Reference Contracting Officer

Name:__________________________________________________

Address: _______________________________________________

Telephone: ___________________ Fax: ___________________

E-mail: _________________________________________________

C. If subcontractors were used, identify the names of the subcontractors and the percentage of the contract the subcontractor was responsible for. ____________________________________________________________________________________________

D. Specify, by name, any key individual(s) who participated in this contract and are proposed to support acquisition detailed in the RFP.

RFP-RC-2025-022 Worker's Compensation and NYSGML 207C Claims Administration

MoodieC Highlight

NAME OF OFFEROR:
Name of Contracting Entity:
Contract Name/Title:
Term of Contract:
Original Contract Value:
Current or Final Contract Value:
A:
1 Original Date:
3 Number of Change Orders (if any):
Primary Causes or Reasons of Change:
Primary Causes or Reasons of Change_1:
2 Current or Final Date:
2 Current or Final Date_1:
responsible for:
D:
D_1:
Name:
Address:
Telephone:
Fax:
E-mail:
Name_1:
Address_1:
Telephone_1:
Fax_1:
E-mail_1:

File details come from the government source that posted it. Updated .