ATTACHMENT LIST OF PAST PERFORMANCE REFERENCES.docx

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J066--598-26-3-6701-0037 PremiumCare epMotion 5075 service agreement POP 6/30/206-6/29/2027
Solicitation number
36C25626Q0550
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This is a past performance references template form required for submission in response to Solicitation 36C25626Q0550, a service agreement opportunity for PremiumCare epMotion 5075 equipment maintenance with the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The form is designed to collect information about three previous contracts that demonstrate the offeror's relevant experience and capability to perform similar work.

The template requires offerors to provide specific details for each of three past performance references, including the contracting activity name and location, contract number, point of contact with telephone number, dollar amount of the contract, and a brief description of services provided. This appendix serves as a structured mechanism for evaluating contractor qualifications and experience history relevant to the proposed service agreement, which covers the period from June 30, 2026 through June 29, 2027. The form does not specify minimum thresholds for contract values, required service types, or evaluation criteria, as these details would typically be found in the solicitation's evaluation section or technical requirements.

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ATTACHMENT 2 – LIST OF PAST PERFORMANCE REFERENCES

36C256-23-Q-13

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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