Attachment 3 - Past Performance Summary Sheet.docx
DOCX document 26 KB Posted
- Solicitation number
- HT941026R2001
- Issued by
-
Defense Health Agency
About this file
This is a Past Performance Summary Sheet template for the Integrated Referral Management and Appointing Center (IRMAC) Services solicitation (RFP HT941026R2001) issued by the Defense Health Agency. The template is designed to collect standardized information from offerors regarding their relevant past performance on similar contracts.
The form requires offerors to provide company identification (name and CAGE code), prime or subcontractor status, and contract or task order numbers with periods of performance, explicitly excluding basic IDIQ contract numbers in favor of specific task order references. Offerors must supply current points of contact from both contracting offices and end-user/customer organizations, including email addresses and phone numbers. The template mandates description of labor categories, service locations, and full-time equivalent (FTE) staffing levels for each project submission. Offerors must document contract or task order award amounts for base years and up to four option years, and report project status including performance metrics, completion years, and any contract terminations or scope modifications. Each past performance project is limited to three pages on this summary sheet. This information will be used to evaluate offeror capability and experience in delivering similar healthcare administrative services to military treatment facilities.
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Text version
RFP: HT941026R2001
ATTACHMENT # 3
Past Performance Summary Sheet
Provide the following information for each past performance reference submitted in response to RFP HT941026R2001. Use one project Summary sheet per project. Limit three pages per project.
Company Name and CAGE:
Company Name:
CAGE:
Sub or Prime?
Contract Number or Task Order number and contract period of performance:
Do not provide IDIQ basic contract numbers. Projects provided under an IDIQ shall reference the Task Order number from which the work was completed.
Contract Number:
Period of performance:
Current point of contact (POC):
Provide current email addresses and phone numbers. Provide two POCs if possible, one from the contracting office and one from the end user/customer.
1.
2.
Description of effort:
Provide the labor categories, location of services and the number of FTEs performed for this effort.
Location:
Labor Category:
# of FTE:
Contract or Task Order Award Amount (Base and Options):
List the amount of the base year and each option year on the contract.
Base year:
Option 1:
Option 2:
Option 3:
Option 4:
Status of the project:
Identify status of performance reporting and how many years have successfully been completed. Identify any terminations or modifications for scope change.
File details come from the government source that posted it. Updated .