Attachment 5 - Past Performance (OPTIONAL).pdf

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Q508--Q&A Amendment VISN 23 Hem/Onc Provider Services for Iowa City, IA Base Year with four Option Years
Solicitation number
36C26323Q0289
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PRESENT AND PAST PERFORMANCE QUESTIONNAIRE

A. PLEASE PROVIDE TWO (2) PAST AND/OR PRESENT PERFORMANCE REFERENCES FOR THE MOST

RECENT, RELEVANT CONTRACTS. PLEASE RETURN THIS PACKAGE WITH YOUR

BID/PROPOSAL/QUOTATION.

OFFEROR’S/BIDDER’S NAME (Company/Division): _________________________________________________

JOB 1

1. CONTRACT NUMBER: ________________________________ 2. TYPE: ____________________________

3. BUYING OFFICE:

a. Address: _________________________________________________________________________________

b. Phone: __________________________________________________________________________________

c. Contracting Officer/Point of Contact: __________________________________________________________

4. BRIEF DESCRIPTION OF EFFORT: ____________________________________________________________

5. CONTRACT $ VALUE: a. Original: _________________________________________________________

b. Value at Completion: _______________________________________________

c. Reason for any Change: _____________________________________________

6. PERFORMANCE PERIOD: a. Date Completed/To Be Completed: ____________________________________

b. Reason for Any Change: ____________________________________________

7. USE THIS SPACE TO ADDRESS ANY TECHNICAL (OR OTHER) AREA OF CONCERN CONSIDERED

UNIQUE: _____________________________________________________________________________________

Attachment 6: Past Performance

OFFEROR’S/BIDDER’S NAME (Company/Division): _________________________________________________

JOB 2

1. CONTRACT NUMBER: ________________________________ 2. TYPE: ____________________________

3. BUYING OFFICE:

a. Address: _________________________________________________________________________________

b. Phone: ___________________________________________________________________________________

c. Contracting Officer/Point of Contact: ___________________________________________________________

4. BRIEF DESCRIPTION OF EFFORT: ____________________________________________________________

5. CONTRACT $ VALUE: a. Original: _________________________________________________________

b. Value at Completion: _______________________________________________

c. Reason for any Change: _____________________________________________

6. PERFORMANCE PERIOD: a. Date Completed/To Be Completed: ____________________________________

b. Reason for Any Change: ____________________________________________

7. USE THIS SPACE TO ADDRESS ANY TECHNICAL (OR OTHER) AREA OF CONCERN CONSIDERED

UNIQUE: _____________________________________________________________________________________

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