Past Performance Questionnaire.docx
DOCX document 26 KB Posted
- Solicitation number
- 45208-PO-21-221
About this file
This sources sought notice requests capability information for physician assistant and nurse practitioner services for the Great Plains Area Indian Health Service. Interested parties considered qualified must submit a two-page maximum response by February 23, 2021 at 10:30 AM CDT/CST to connie.valandra@ihs.gov with the subject line "Physician Assistant/Nurse Practitioner [PA/NP (CNMW/PSYCH)] Services-Sources Sought." Responses should include organization details, tailored capability statements addressing the statement of work with supporting documentation, and a past performance questionnaire. The requirement may be set aside under the Buy Indian Act or procured through full and open competition, with potential for multiple awards. The NAICS code is 561320 and classification code is Q201.
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Other files
| File | Type | Posted |
|---|---|---|
| SOW - OPD PA-NP CNMW PSYCH Revised 01.12.21.doc | DOC document |
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Physician Assistant/Nurse Practitioner [PA/NP (CNMW/PSYCH)]
PAST PERFORMANCE QUESTIONNAIRE
1. Contract Number: ____________________________________________
2. Indicate whether you were the prime contractor or subcontractor.
[ ] Prime Contractor [ ] Subcontractor
3. Contract Award Period:_________________________________________
4. Contract Type (e.g., Fixed-Price, Cost-Reimbursement, etc.)
5. Contract Term (e.g., One Year, Base Year and Options).
6. Contract Dollar Value:__________________________________________
7. Name of Procuring Organization:
8. Address of Procuring Organization:
9. Contracting Officer’s Name and Phone Number:
10. Program Manager or COTR’s Name and Phone Number:
11. Provide information on problems encountered on the identified contract and the corrective action taken.
12. Provide a brief summary of the work accomplished and how it relates to the work required by this solicitation.
45208-PO-21-221 Sources Sought Notice Page 1
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