ATTACHMENT 5 - Past Performance Reference Form.docx
DOCX document 23 KB Posted
- Attached to
- Y1NA--CON | NRM 653-23-100 | Remove Replace Underground Fuel Tanks Federal contract opportunity
- Solicitation number
- 36C26026R0076
About this file
This is a Past Performance Reference Form template for solicitation 36C26026R0076, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 20 for the removal and replacement of underground fuel tanks. The form is designed to collect reference information that the VA will use to evaluate contractor past performance capabilities.
The form requires offerors to provide two points of contact (primary and alternate) who are familiar with referenced construction projects and have direct affiliation with the contractor as current or former employees, relatives, or in roles such as Contract Officers, Contract Specialists, Contract Officer Representatives, or Engineers. For each reference project, offerors must supply the reference company or agency name, award number if applicable, project title, contract period of performance, work location with complete address, total award dollar amount, and contact information including names, phone numbers, and email addresses for both POCs. Offerors must also indicate whether the contractor served as a prime contractor or sub-contractor and provide a description of work performed. This template is an appendix to the solicitation and does not contain specific performance requirements or deliverables for the fuel tank removal and replacement project itself.
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Text version
ATTACHMENT 5 – PAST PERFORMANCE REFERENCE FORM
PAST PERFORMANCE REFERENCE FORM: 36C26026R0076 Remove Replace Underground Fuel Tanks
INSTRUCTIONS TO OFFEROR
The information below is for reference checks. A primary point of contact (POC) and an alternate POC is required. The POCs listed below shall be familiar with the construction project being referenced and have direct affiliation with the contractor (i.e. current or former employee, relative). Examples of POCs include but are not limited to Contract Officers, Contract Specialists, Contract Officer Representatives, and Engineers. This form may be used by the VA to contact each POC for past performance information.
Reference Company/Agency Name
Reference Award Number (if applicable)
Reference Project Title
Contract Period of Performance (start to finish)
Location of work building/street address
Total Award Dollar Amount
City
State and Zip Code
First Point of Contact (POC) Name
Second POC Name
First POC Phone Number
Second POC Phone Number
First POC Email Address
Second POC Email Address
Role of Contractor on This Project (check appropriate box)
Prime Contractor Sub-contractor Key Personnel
Description of Work
File details come from the government source that posted it. Updated .