ATTACHMENT C LIST OF PAST PERF REF.docx

DOCX document 21 KB Posted

Attached to
S209--Floor mat services
Solicitation number
36C25627Q0028
Issued by

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This is a Past Performance References template form for solicitation 36C25627Q0028 that requires contractors to submit documentation of prior relevant experience. The form requests three separate past performance references, with each reference requiring the contracting activity name, location, contract number, point of contact information, telephone number, dollar amount, and a brief description of services provided.

This template is part of the evaluation requirements for a floor mat services solicitation issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 for the Gulf Coast Veterans Health Care System and Mobile Outpatient Clinic Network in Alabama and Mississippi. The underlying solicitation is set aside for Service-Disabled Veteran-Owned Small Businesses, has a NAICS code of 812332, and quotes are due by October 28, 2026 at 12:00 PM CT with contract performance running from January 1, 2027 through December 31, 2027, plus four optional 12-month renewal periods.

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ATTACHMENT C – LIST OF PAST PERFORMANCE REFERENCES

36C25627Q0028

PAST PERFORMANCE REFERENCES

REFERENCE 1:

Contracting Activity Name:_________________________________ Location:_____________________________________ Contract Number:______________________________ Point Of Contact:______________________________ Telephone Number:____________________________ Dollar Amount:__________________ Brief Description of Services Provided: _______________________________________

REFERENCE 2:

Contracting Activity Name:_________________________________ Location:_____________________________________ Contract Number:______________________________ Point Of Contact:______________________________ Telephone Number:____________________________ Dollar Amount:__________________ Brief Description of Services Provided: _______________________________________

REFERENCE 3:

Contracting Activity Name:_________________________________ Location:_____________________________________ Contract Number:______________________________ Point Of Contact:______________________________ Telephone Number:____________________________ Dollar Amount:__________________ Brief Description of Services Provided: _______________________________________

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