Attch D_3 Reference Contract Worksheet Home O2.docx
DOCX document 16 KB Posted
- Attached to
- Home Oxygen and Ventilator Services - VISN 16
- Solicitation number
- 36C25626R0037
About this file
This is a reference contract worksheet template for home oxygen services. The document appears to be a blank form designed to capture and organize key contracting information related to existing or comparable home oxygen delivery contracts within the Veterans Health Administration system. As a template file, it does not contain specific details about required products, services, pricing terms, or performance requirements for the current solicitation (36C25626R0037). The worksheet is intended to serve as a standardized tool for contractors or government personnel to reference and document contract-related data that may inform proposals or evaluations for the Home Oxygen and Ventilator Services solicitation under VISN 16, but the actual populated data and specific contracting terms are not included in this attachment.
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Other files
| File | Type | Posted |
|---|---|---|
| UPDATED 9-15-26 - Attachment D_136C25626R0037 Pricing Schedule.xlsx | XLSX spreadsheet | |
| 36C25626R0037 - Am 3.pdf | ||
| Technical Questions and Responses - 36C25626R0037.docx | DOCX document | |
| 36C25626R0037 Amendment 0002.pdf | ||
| UPDATED - Performance Work Statement - Home Oxygen 3-station.pdf | ||
| UPDATED - Attachment D_136C25626R0037 Pricing Schedule.xlsx | XLSX spreadsheet | |
| 36C25626R0037 Amendment 0001.pdf | ||
| Attch D_2 Business Associate Agreement.pdf | ||
| Attch D_4 - Counties and Parishes.docx | DOCX document | |
| Attch D_5 QUALITY ASSURANCE SURVEILLANCE PLAN 3-stations.pdf | ||
| Copy of DELIVERY.xlsx | XLSX spreadsheet | |
| 36C25626R0037 Final.pdf | ||
| Attch D_1 36C25626R0037 Pricing Schedule.xlsx | XLSX spreadsheet |
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Text version
Attachment D.3 – Reference Contract Worksheet for Offeror’s Response to Factor 1 – Experience Reference Contract Number ______
The legal name of entity with whom the Offeror held the contract
Contract Number
Whether the contract was for in-home oxygen services, in-home ventilator services or both
A description providing details of the specific tasks the Offeror performed under that Contract
Attachment D.3 – Reference Contract Worksheet for Offeror’s Response to Factor 1 – Experience
Geographic location in which the Offeror performed these services
The dates during which the Offeror performed the contract
| The number of patients to whom the Offeror provided in-home oxygen services or in-home ventilator services, or both, under that contract – break out and specify numbers separately for in-home oxygen services and in-home ventilator services |
| Number of in-home oxygen patients served each month __________ |
Number of in-home ventilator patients served each month __________
Whether the provided reference contract is for services provided by the Offeror or provided by a proposed subcontractor of the Offeror’s
Whether the Offeror or its proposed subcontractor was the prime contractor or a subcontractor for that provided reference contract
The name, phone number, and email address of a person at the entity with whom the Offeror (or Offeror’s proposed subcontractor) held the contract who can verify the information the Offeror provides in the narrative description for this factor
File details come from the government source that posted it. Updated .