Attachment 2 - Reference Sheet.pdf
PDF 354 KB Posted
- Attached to
- Opthtalomogy Laser Maintenance - Travis AFB, CA - Amendment 1 Federal contract opportunity
- Solicitation number
- FA442720R0047
About this file
This document contains a reference sheet template for a federal contractor to list past performance examples on ophthalmology laser maintenance and repair services. The template requests information on three past contracts including contract number, description of work, period of performance, contracting agency points of contact, contract values including total, annual amounts and periods of performance for annual values, and whether work was performed as a prime, subcontractor, affiliate, or joint venture. For any subcontracted, affiliated, or joint venture work, the contractor must provide the percentage of work performed, cost split, and type of services provided.
The related solicitation is for ophthalmology laser maintenance services on government-owned equipment located at the 60th Medical Group at Travis Air Force Base in California. The services include preventative maintenance by OEM-certified technicians using new OEM parts, unlimited repairs and parts, manufacturer telephone support, and service reports. The period of performance is not specified. The solicitation was issued by the Department of the Air Force Air Mobility Command.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment FA442720R00470001 SF 30.pdf | ||
| Solicitation - FA442720R0047.pdf | ||
| Attachment 1 - PWS Opthtalomogy Laser Maintenance v2.pdf | ||
| Attachment 4 - Wage Determination 15-5656.pdf | ||
| Attachment 3 - Past Performance Questionnaire (PPQ).doc | DOC document |
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Text version
Attachment 3 - List of References MFT 21-13
PAST PERFORMANCE LIST OF REFERENCES
Vendor Name:
CONTRACT NUMBER
(include task order number(s) if applicable)
DESCRIPTION OF WORK PERFORMED
(performed as a prime/sub-contractor, details i.e.
type of equipment, 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)
1.
2.
1.
2.
1.
2.
Attachment 3 - List of References MFT 21-13
File details come from the government source that posted it. Updated .