Atch 4 - Past Performance List of_References.pdf
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- Solicitation number
- FA301625Q6029
About this file
Attachment 4 is a Past Performance List of References template for an Aerospace Medicine Physician (Flight Surgeon) solicitation from the Department of the Air Force Air Education and Training Command. The two-page document provides a structured form for contractors to list their previous contract work, including details such as contract numbers, description of work performed, full-time equivalent (FTE) staffing, contract periods of performance, contracting agency points of contact, and total and annual contract values. The template includes spaces for three separate past performance references and a second page that allows contractors to describe any subcontractor, affiliate, or joint venture arrangements, including the percentage of work, cost splitting, and specific services performed.
The solicitation (FA301625Q6029) seeks 4 Aerospace Medicine Physicians to provide rotational/temporary medical support across 11 AETC Medical Treatment Facilities and units, addressing a chronic manning shortage of active-duty flight surgeons. The template is designed to help evaluate potential contractors' previous experience and performance in similar medical support roles, with a focus on capturing comprehensive details about prior contract work that demonstrates capability to meet the current requirement for operational medical support in flying training programs.
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Text version
Attachment 4 – Past Performance List of References Aerospace Medicine Physician (Flight Surgeon)
Solicitation# FA301625Q6029
PAST PERFORMANCE LIST OF REFERENCES
Company Name:
CPARS
Y/N
CONTRACT NUMBER
(include task order number(s) if applicable)
DESCRIPTION OF WORK
PERFORMED
(performed as a prime/sub-contractor, details i.e. number of FTE, position type, full-time or session-based, %performed, etc. )
FTE
CONTRACT
PERIOD OF
PERFORMANCE
(POP)
CONTRACTING AGENCY POC/CUSTOMER
NAME, PHONE # & EMAIL
CONTRACT VALUES
(include total contract amount, annual amount and POP for annual amount)
PERFORMED AS A PROPOSED
SUBCONTRACTOR,
AFFILIATE, OR
JOINT VENTURE?
(If yes, please complete Page 2)
Total: $
Annual: $
POP for Annual:
Total: $
Total: $
Attachment 4 – Past Performance List of References Aerospace Medicine Physician (Flight Surgeon)
Solicitation# FA301625Q6029
CONTRACT NUMBER
(include task order number(s) if applicable)
SUBCONTRACTOR,
AFFILIATE, OR
JOINT VENTURE
DESCRIBE FUNCTION/TASK/3RD PARTY AFFECT ON PERFORMANCE
1. If proposing to use a Subcontractor, Affiliate, or Joint Venture for this effort, include percentage of work, splitting of cost, type of services i.e. accounting, recruiting, etc they will perform for this effort (provide information below)
2. If contractor proposing on this effort provided past performance they performed as a Subcontractor, Affiliate, or Joint Venture, include percentage of work, splitting of cost, type of services performed, i.e. accounting, recruiting, etc for that effort (provide information below)
1.
2.
File details come from the government source that posted it. Updated .