D.1 Reference Contract Work sheet.pdf
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- Solicitation number
- 36C26226Q0021
About this file
This document is a Reference Contract Worksheet template (Attachment 1) for Factor 1 - Experience, associated with solicitation 3626226Q0021, designed for offerors to provide detailed information about their prior experience in cooling tower disinfection services within healthcare settings. The worksheet requires comprehensive documentation including the legal name of the contract holder, contract number, geographic service location, contract dates, average monthly staffing levels, contract type (prime or subcontractor), and contact information for reference verification. The template is structured to capture multiple reference contracts, allowing offerors to demonstrate their relevant experience by providing granular details about previous cooling tower disinfection service contracts in healthcare environments.
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Text version
3626226Q0021
D.1 ATTACHMENT 1 – REFERENCE CONTRACT WORKSHEET FOR
OFFEROR’S RESPONSE TO FACTOR 1 – EXPERIENCE
Reference Contract Number ______
The legal name of entity with whom the Offeror (or Offeror’s proposed subcontractor) held the contract (examples: Molina Healthcare, VA Long Beach Healthcare system, VISN 22
Contract Number
Whether the contract was for cooling tower disinfection services in a healthcare setting;
A detailed description providing details of the specific tasks the Offeror (or Offeror’s proposed subcontractor) performed under that Contract
3626226Q0021
In what geographic location the Offeror (or Offeror’s proposed subcontractor) performed these services
(example: Los Angeles and Orange counties)
The dates during which the Offeror (or Offeror’s proposed subcontractor) performed the contract
The average monthly number of Cooling Tower Disinfection Services Staff the Offeror (or Offeror’s proposed subcontractor) provided for each labor category under that contract
Cooling Tower Disinfection Services Staff ____________
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
D.1 ATTACHMENT 1 – REFERENCE CONTRACT WORKSHEET FOR OFFEROR’S RESPONSE TO FACTOR 1 – EXPERIENCE
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