Attachment D6 - Past Performance Reference.pdf
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- Solicitation number
- 36C25625Q0129
About this file
This is a past performance reference template (Attachment D.6) for RFQ 36C25625Q0129 related to Intraoperative Nerve Monitoring (IONM) services at the Michael E. DeBakey VA Medical Center in Houston, Texas.
The template provides space for offerors to submit three past performance references, with fields for each reference including: organization name, address, contract number, brief description, role (prime/sub), performance dates, total contract cost, awards/incentives/deductions, termination history, and point of contact information. This is a standard form template that does not contain any completed reference information.
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Text version
ATTACHMENT D.6 PAST PERFORMANCE
– 36C25623Q0090 Registered Nurse Services RFQ 36C256Q0129
PAST PERFORMANCE REFERENCES
REFERENCE 1:
Name of Government or Commercial Organization: Address:
Contract Number:
Brief Description:
Contractor Performed as:
Prime Contractor
Sub-Contractor
Dates of Performance (if current include expiration):
Total Cost of Contract: Award/Incentive/Deduction Any terminations for cause or default? Circle YES or NO If yes, brief explanation:
Point Of Contact/COR:
Title:
Telephone Number:
Point of Contact’s email address:
Comments:
REFERENCE 2:
Name of Government or Commercial Organization:
Address:
Contract Number:
Brief Description:
Contractor Performed as:
Prime Contractor
Sub-Contractor
Dates of Performance (if current include expiration):
Total Cost of Contract: Award/Incentive/Deduction Any terminations for cause or default? Circle YES or NO If yes, brief explanation:
Point Of Contact/COR:
Title:
Telephone Number:
Point of Contact’s email address:
Comments:
REFERENCE 3:
Name of Government or Commercial Organization:
Address:
Contract Number:
Brief Description:
Contractor Performed as:
Prime Contractor
Sub-Contractor
Dates of Performance (if current include expiration):
Total Cost of Contract: Award/Incentive/Deduction Any terminations for cause or default? Circle YES or NO If yes, brief explanation:
Point Of Contact/COR:
Title:
Telephone Number:
Point of Contact’s email address:
Comments:
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