ATTACHMENT E Past Performance Reference.docx
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- Solicitation number
- 36C24226R0081
About this file
This is a Past Performance Reference form attachment to a federal solicitation for home oxygen services through the Department of Veterans Affairs (VA) Veterans Health Administration, Veterans Integrated Service Network (VISN) 2, specifically for the Downstate region.
Offerors are required to provide a minimum of three (3) past performance references from businesses or medical facilities of similar size and scope that have supplied the offered services within the past three years. For each reference, offerors must document the contract number, estimated contract value, period of performance, contracting agency or company name, and current point of contact information (including name, title, phone number, and email address). Additionally, offerors must provide a brief description of each contract that demonstrates relevance in scope to the prosthetics downstate home oxygen services requirement. The form provides space for up to five references, and offerors bear responsibility for ensuring all contact information is current and accurate so that references can respond to performance evaluation inquiries.
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ATTACHMENT E – PAST PERFORMANCE REFERENCE INFORMATION
Offeror shall complete the listing of past performance references below, including at least three (3) businesses or medical facilities of similar size and scope to this solicitation, that have purchased the offered services in the past three (3) years. References listed must be familiar with the contract and able to answer questions about performance and adherence to requirements. The offeror is responsible for ensuring contact information for all past performance references is the most recent and valid information available.
For each past performance reference identified below, the offeror shall include the following information:
· Contract Number
· Contract Value
· Period of Performance
· Name of agency or company contract was with
· Current Point of Contact information (including: name, title or position, phone number, and email address) that can provide performance feedback information.
· Brief description of the contract demonstrating the relevance in scope to this requirement.
Reference 1:
Contract Number
Est. Contract Value
Period of Performance
Name of Agency/Company
Current Point of Contact
Name
Title/Position
Phone Number
Email Address
Brief Description of Contract
Reference 2:
Contract Number
Est. Contract Value
Period of Performance
Name of Agency/Company
Current Point of Contact
Name
Title/Position
Phone Number
Email Address
Brief Description of Contract
Reference 3:
Contract Number
Est. Contract Value
Period of Performance
Name of Agency/Company
Current Point of Contact
Name
Title/Position
Phone Number
Email Address
Brief Description of Contract
Reference 4:
Contract Number
Est. Contract Value
Period of Performance
Name of Agency/Company
Current Point of Contact
Name
Title/Position
Phone Number
Email Address
Brief Description of Contract
Reference 5:
Contract Number
Est. Contract Value
Period of Performance
Name of Agency/Company
Current Point of Contact
Name
Title/Position
Phone Number
Email Address
Brief Description of Contract
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