Attachment 6 Past Performance Questionnaire.pdf
PDF 55 KB Posted
- Attached to
- Lincoln, NE Emergency Homeless Shelter Services
- Solicitation number
- 36C26322Q0217
About this file
This solicitation requests proposals for emergency shelter and related services in Lincoln, Nebraska. The Department of Veterans Affairs Veterans Health Administration Network Contracting Office 23 is seeking to support the VA Nebraska-Western Iowa Health Care System's Health Care for Homeless Veterans program. Offerors must be able to provide all services outlined in the performance work statement, starting April 1, 2022. Proposals are due by March 11, 2022. Interested parties must register in the System for Award Management and Veterans Information Portal databases. The North American Industry Classification code is 624221 for temporary shelters with a small business size standard of $12 million.
The solicitation provides instructions on downloading the full document from SAM.gov and submitting proposals to Matthew Dale at the listed email address. It includes the solicitation number for reference and lists the contracting office address.
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Text version
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 Questionnaire
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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