Attachment 3-Relevant Experience Form.docx

DOCX document 20 KB Posted

Attached to
R410--Magnet Consultation Michael E. DeBakey VAMC Federal contract opportunity
Solicitation number
36C25624Q1468
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

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This document is an Attachment A Relevant Experience Form that is part of a Request for Quote (RFQ) solicitation with the number 36C25624Q1468 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The RFQ is for magnet consultation services at the Michael E. DeBakey VA Medical Center in Houston, TX.

The RFQ is a total small business set-aside with a NAICS code of 541611 and a size standard of $24.5M. The period of performance is from the date of award through September 30, 2025. Quotes are due by September 19, 2024 at 11:59 PM Central Time and should be submitted electronically to the Contracting Officer, Jeneice Matthews. The Government anticipates awarding one Firm-Fixed Price contract resulting from this solicitation.

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Other files for this federal contract opportunity

Other files attached to R410--Magnet Consultation Michael E. DeBakey VAMC, newest first.
File Type Posted
S02- 36C25624Q1468 Magnet Consultation.pdf PDF
Attachment 2- 852.219-75 VA NOTICE OF LIMITATION ON SUBCONTRACTING.docx DOCX document
Attachment 1-WD 2015-5233 REV 28 07-22-2024.pdf PDF

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ATTACHMENT A

RELEVANT EXPERIENCE FORM

Please list your contracts in the chronological order beginning with the most recent one. Contracts listed cannot be more than 5 years old. You can list ongoing contracts that began more than 5 years ago.

Contract #1

1.Customer Name
2. Customer’s Address
3.Name and Title of Contact Point
4.Contact Point’s Email Address
5.Contact Point’s Phone Number
6.Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status ___Ongoing ___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request For Quote documents. Attach separate sheet if additional space is needed.)

36C25624Q1468

Contract #2

1.Customer Name
2. Customer’s Address
3.Name and Title of Contact Point
4.Contact Point’s Email Address
5.Contact Point’s Phone Number
6.Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request For Quote documents. Attach separate sheet if additional space is needed.)

Contract #3

1.Customer Name
2. Customer’s Address
3.Name and Title of Contact Point
4.Contact Point’s Email Address
5.Contact Point’s Phone Number
6.Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the Request For Quote documents. Attach separate sheet if additional space is needed.)

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