Attachment 4 Past Performance Contacts.docx
DOCX document 98 KB Posted
- Attached to
- Q301--Referral Lab Services - VISN 15
- Solicitation number
- 36C25521R0004
About this file
This document contains a federal contract opportunity solicitation and a past performance reference template. The solicitation is for Referral Laboratory Services for Veterans Integrated Services Network 15 within the Department of Veterans Affairs. Services required include pre-analytic processing, analysis, and result interpretation for clinical and anatomical pathology specimens. The NAICS code is 621511 for medical laboratories with a small business size standard of $35 million. The solicitation is anticipated to be issued on December 1, 2020 and will be posted on beta.sam.gov. The past performance reference template requests contact information for a minimum of three current or past laboratory testing contracts within the last three years for reference checks. Proposals are due as instructed in the solicitation.
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Text version
Offeror: _____________________ Past Performance Survey
Provide a minimum of three current/past performance references below for laboratory testing services conducted within the past three years, to include the names and phone numbers of responsible individuals who would have firsthand knowledge of the performance. The Government reserves the right to review other past performance records. Records found with unsubstantiated unsatisfactory past performance history may assess the offer as technically unacceptable.
Business Name: _____________________________________________________________
Business Address: ___________________________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
| Past Performance Survey |
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