ATTACHMENT C - PAST PERFORMANCE REFERENCES TEMPLATE.pdf
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- Solicitation number
- 36C10X21R0036
About this file
This document provides a template for offerors to submit past performance references as part of a solicitation response. The solicitation seeks a contractor to provide technical and professional support services to various Department of Veterans Affairs medical centers, clinics, and offices. Services include corrective and planned equipment maintenance, professional biomedical engineering work, and project management. Resources may support both routine operational tasks as well as unexpected pandemic or readiness initiatives. Local contracting officers will oversee contractors assigned to their facilities. Successful offerors must execute a Business Associate Agreement to handle protected health information. Contractors will augment government staff in a non-personal support role under technical oversight. Inherently governmental functions remain with the government.
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D.1 ATTACHMENT C: PAST PERFORMANCE REFERENCES
No record of relevant or recent past performance Past Performance Reference # 1
OFFEROR NAME:
COMPANY who performed this work:
Relationship to OFFEROR: OFFEROR PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: PRIME SUBCONTRACTOR
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and Telephone Number:
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed: YES NO Description of the Requirement: Provide a concise explanation of the work performed, specifically related to how it is relevant to this solicitation’s requirements.
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report for this reference are to be addressed.
Past Performance Reference # 2
OFFEROR NAME:
COMPANY who performed this work:
Relationship to OFFEROR: OFFEROR PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: PRIME SUBCONTRACTOR
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and Telephone Number:
Program Manager's Name, Email, and
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed: YES NO Description of the Requirement: Provide a concise explanation of the work performed, specifically related
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report
Past Performance Reference # 3
OFFEROR NAME:
COMPANY who performed this work:
Relationship to OFFEROR: OFFEROR PROPOSED SUBCONTRACTOR
WORK PERFORMED AS THE: PRIME SUBCONTRACTOR
Name of Contracting Organization:
Contract / Task Order Number (for subcontracts, provide the prime contract number and the subcontract number):
Contract Type:
Total Awarded Price/Cost:
Final or Projected Final Total Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer's Name, Email, and
Program Manager's Name, Email, and
North American Industry Classification System (NAICS) Code:
CPARS/PPIRS Completed: YES NO Description of the Requirement: Provide a concise explanation of the work performed, specifically related
Performance: Explain any performance issues or problems that occurred, corrective actions taken, and any expected or realized results based on those corrective actions. Any issues discussed in a CPARS/PPIRS report
| Past Performance Reference 1: |
| OFFEROR NAME: |
| COMPANY who performed this work: |
| OFFEROR: Off |
| PROPOSED SUBCONTRACTOR: Off |
| PRIME: Off |
| SUBCONTRACTOR: Off |
| PRIME SUBCONTRACTORName of Contracting Organization: |
| PRIME SUBCONTRACTORContract Task Order Number for subcontracts provide the prime contract number and the subcontract number: |
| PRIME SUBCONTRACTORContract Type: |
| PRIME SUBCONTRACTORTotal Awarded PriceCost: |
| PRIME SUBCONTRACTORFinal or Projected Final Total PriceCost: |
| PRIME SUBCONTRACTORDelivery datePeriod of performance including base and options if applicable: |
| PRIME SUBCONTRACTORContracting Officers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORProgram Managers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORNorth American Industry Classification System NAICS Code: |
| CPARSPPIRS Completed: |
| undefined: |
| NO: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations requirements: |
| Performance Explain any performance issues or problems that occurred corrective actions taken and any expected or realized results based on those corrective actions Any issues discussed in a CPARSPPIRS report for this reference are to be addressed: |
| OFFEROR NAME_2: |
| COMPANY who performed this work_2: |
| OFFEROR_2: |
| PROPOSED SUBCONTRACTOR_2: |
| undefined_2: |
| PRIME_2: |
| SUBCONTRACTOR_2: |
| Name of Contracting Organization: |
| Contract Task Order Number for subcontracts provide the prime contract number and the subcontract number: |
| Contract Type: |
| Total Awarded PriceCost: |
| Final or Projected Final Total PriceCost: |
| Delivery datePeriod of performance including base and options if applicable: |
| Contracting Officers Name Email and Telephone Number: |
| Program Managers Name Email and Telephone Number: |
| North American Industry Classification System NAICS Code: |
| CPARSPPIRS Completed_2: |
| YES: |
| NO_2: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related_2: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations requirements_2: |
| Performance Explain any performance issues or problems that occurred corrective actions taken and any expected or realized results based on those corrective actions Any issues discussed in a CPARSPPIRS report for this reference are to be addressed_2: |
| OFFEROR NAME_3: |
| COMPANY who performed this work_3: |
| OFFEROR_3: |
| PROPOSED SUBCONTRACTOR_3: |
| undefined_3: |
| PRIME_3: |
| SUBCONTRACTOR_3: |
| Name of Contracting Organization_2: |
| Contract Task Order Number for subcontracts provide the prime contract number and the subcontract number_2: |
| Contract Type_2: |
| Total Awarded PriceCost_2: |
| Final or Projected Final Total PriceCost_2: |
| Delivery datePeriod of performance including base and options if applicable_2: |
| Contracting Officers Name Email and Telephone Number_2: |
| Program Managers Name Email and Telephone Number_2: |
| North American Industry Classification System NAICS Code_2: |
| CPARSPPIRS Completed_3: |
| YES_2: |
| NO_3: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related_3: |
| Description of the Requirement Provide a concise explanation of the work performed specifically related to how it is relevant to this solicitations requirements_3: |
| Performance Explain any performance issues or problems that occurred corrective actions taken and any expected or realized results based on those corrective actions Any issues discussed in a CPARSPPIRS report for this reference are to be addressed_3: |
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