Attachment 3- Past Performance List of References.pdf
PDF 98 KB Posted
- Attached to
- Cardiovascular Center Staffing
- Solicitation number
- FA301021R0001
About this file
This document contains an attachment listing past performance references for a federal solicitation. The solicitation seeks cardiovascular center staffing services to support a medical center at Keesler Air Force Base. The required services include three full-time cardiac catheterization laboratory technicians, two full-time registered nurses for cardiology clinic and catheterization laboratory services, one full-time nurse practitioner for cardiology services, one full-time registered nurse for cardiology clinic utilization management and team lead, one full-time medical coder for cardiovascular services, and one full-time picture archiving and communications system administrator for cardiovascular services. The attachment provides a template for offerors to list up to three relevant past performance references that include contract details such as period of performance, contracting agency points of contact, and contract values. Space is also provided to identify if work was performed by subcontractors or joint ventures.
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Attachment 3-List of References Solicitation #: FA301021R0001
Cardiovascular Center Staffing
(3) Technicians - Cardiac Catheterization Laboratory, (2) Registered Nurses (RN) - Cardiology Clinic/Cardiac Catheterization Laboratory, (1) Nurse Practitioner (NP) - Cardiology Services, (1) RN - Cardiology Clinic/Utilization Management/Team Lead, (1) Medical Coder - Cardiovascular, and (1) Picture Archiving and Communications System (PACS) - Cardiovascular
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:
Attachment 3-List of References Solicitation #: FA301021R0001
Cardiovascular Center Staffing
(3) Technicians - Cardiac Catheterization Laboratory, (2) Registered Nurses (RN) - Cardiology Clinic/Cardiac Catheterization Laboratory, (1) Nurse Practitioner (NP) - Cardiology Services, (1) RN - Cardiology Clinic/Utilization Management/Team Lead, (1) Medical Coder - Cardiovascular, and (1) Picture Archiving and Communications System (PACS) - Cardiovascular
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 .