7 Atch 4 PPRL.pdf

Attachment 4

Solicitation No. FA520921U0011

PAST PERFORMANCE REFERENCE LIST

BEHAVIORAL HEALTH OPTIMIZATION PROGRAM PROVIDER (BHOP) FOR 374th MEDICAL GROUP YOKOTA AIR BASE, JAPAN

1. Name of contracting activity (your customer)

2. Name and title of point of contact (POC);

Contracting Officer or/and Government

Inspector/commercial project manager’s phone/Fax number, and e-mail address

Tel:

Fax:

e-mail:

3. Contract number and project title

4. Contract Type (e.g. Firm-Fixed Price, IDIQ, Requirements type)

5. Total contract value (annual)

6. Performance period

(e.g. date/month/year through date/month/year)

7. Description of contract work performed

Details

8. Contracting Officer’s name and phone number

9. Government Inspector/commercial project manager and phone number

10. List of major subcontractors if applicable

OFFEROR’S NAME (Company Name): _______________________________________________________________