Attachment 6 - Past Performance.pdf
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- Solicitation number
- 36C26323Q1107
About this file
This document contains a past performance questionnaire for federal contractors to provide references from previous relevant contracts. It requests information on up to two past or present contracts, including contract number, type, buying office details, description of work performed, original and final contract values and reasons for any changes, performance period dates and reasons for any changes, and space for additional comments.
The related federal contract opportunity is a five-year solicitation from the Department of Veterans Affairs for otolaryngology/ENT physician services at the San Francisco VA Health Care System, with a period of performance from November 1, 2023 through October 31, 2028. The solicitation number and opportunity type are provided.
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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
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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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