Attach 3-Past Performance List of References.pdf
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- Attached to
- Warfighter/Ophthalmology Clinic Staffing
- Solicitation number
- FA301021R0014
About this file
This attachment provides a list of references template for a solicitation seeking one full-time equivalent refractive surgery optometrist, five ophthalmic technicians, one clinic manager, and two medical records clerks to staff a warfighter ophthalmology clinic at Keesler Air Force Base, Mississippi. Offerors must provide up to three past performance references for relevant contracts describing the work performed, contract period of performance, contracting agency point of contact information, and contract values including total, annual amounts, and period of performance for annual values. If using subcontractors for more than 50% of the work, offerors must also specify the subcontractor, percentage of work split, and type of services to be provided. Proposals are due by the date specified in solicitation number FA301021R0014, with a period of performance from October 1, 2021 through September 30, 2022 and four optional one-year extensions. Questions regarding the solicitation should be directed to the points of contact listed.
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Attachment 3-List of References Solicitation #: FA301021R0014 War-fighter Ophthamology Clinic
Refractive Surgery Optometrist (one FTE), Ophthalmic Technician (five FTE), Clinic Manager (one FTE) and Medical Records Clerks (two FTEs)
PAST PERFORMANCE LIST OF REFERENCES
Company Name:________________________________
CONTRACT NUMBER
(include task order number(s) if applicable) Identify if CPAR is available.
If so, no PPQ is required.
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. )
CONTRACT
PERIOD OF
PERFORMANCE
(POP)
CONTRACTING AGENCY
POC/CUSTOMER NAME, PHONE #
CONTRACT VALUES
(include total contract amount, annual amount and POP for annual amount)
PERFORMED BY A
PROPOSED
SUBCONTRACTOR,
AFFILIATE, OR
JOINT VENTURE?
(If yes, please complete Page 2)
Total: $
Annual: $
POP for Annual:
Total: $
Annual: $
POP for Annual:
Total: $
Annual: $
POP for Annual:
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)
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Attachment 3-List of References Solicitation #: FA301021R0014 War-fighter Ophthamology Clinic
Refractive Surgery Optometrist (one FTE), Ophthalmic Technician (five FTE), Clinic Manager (one FTE) and Medical Records Clerks (two FTEs)
File details come from the government source that posted it. Updated .