Attachment 7 Past Performance.pdf
PDF 312 KB Posted
- Solicitation number
- 36C26324Q0024
About this file
This document contains a past performance questionnaire template for federal contractors to provide references from previous, relevant contracts. It requests information on up to two past or present jobs, including contract number, type, buying office details, brief description of work, 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 solicitation from the Department of Veterans Affairs Veterans Health Administration VISN 23 seeking proposals for certified registered nurse anesthetist services in St. Cloud, Minnesota. No other details are provided on requirements, response dates, or award information.
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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: _____________________________________________________________________________________
Past Performance Questionnaire Note: Completion of this attachment is optional. Offeror may also provide the information requested in this PDF via other formats as desired (word, direct email, etc).
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: _____________________________________________________________________________________
File details come from the government source that posted it. Updated .