ATT D29 PAST PERFORMANCE REFERENCES.docx
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- Solicitation number
- 36C25625R0028
About this file
This is a past performance reference template (Attachment D33) for the Kosciusko CBOC solicitation that provides space for offerors to submit three past performance references. The template requires offerors to provide detailed information for each reference including the organization name, contract number, CPARS availability, brief description of work, role as prime or sub-contractor, performance dates, total contract cost, any terminations, and point of contact details including COR information.
The form explicitly reminds offerors that they are responsible for ensuring their references submit completed Past Performance Questionnaires (referenced as Attachment D28) to the Contracting Officer by the solicitation due date. The template appears to be part of solicitation 36C25625R0028 for the Department of Veterans Affairs Veterans Health Administration VISN 16 related to Kosciusko CBOC services.
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ATTACHMENT D33 - Kosciusko CBOC
PAST PERFORMANCE REFERENCES
Reminder to offeror- it is your responsibility to send Past Performance Questionnaires (ATT D28) to your references listed below and ensure they are received by the Contracting Officer by due date of solicitation.
Please note if available in CPARS.
REFERENCE 1:
Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ CPARS- yes/no (circle one) Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________
REFERENCE 2:
Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ CPARS- yes/no (circle one) Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________
REFERENCE 3:
Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ CPARS- yes/no (circle one) Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________
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