Attachment 1 - Past Performance Information Sheet.docx

Attachment 1—Past Performance Information Sheet

1. Verified POC information to include name, title, phone number, e-mail address, agency name, and address:

2. Contract Number and Task Order number(s), if applicable:

3. Name of contractor to whom the contract was awarded. Provide the CAGE Code and DUNS numbers of the awardee:

4. Dates when services were provided:

5. Place(s) of performance:

6. List the number and type of medical administrative support workers provided. (i.e., Medical Clerical Support, Patient Administration Support Services, or Medical Records Support, etc.) Specify if services were full time, part time, temporary, or locum tenens types of services:

7. Include a statement reflecting an annual account of records coded per type (Outpatient (OP) and Inpatient (IP)).

8. The contractor shall provide information on problems encountered on the identified contract(s) and the contractor’s corrective actions:

9. Was this contract and/or task order terminated? If so, the offeror shall indicate the type of termination and reason(s) for the termination.