D.1 Reference Contract Worksheet.docx
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- Solicitation number
- 36C26221R0082
About this file
This document includes an attachment for a Reference Contract Worksheet and details of a related federal contract opportunity.
The Reference Contract Worksheet attachment requests information from offerors on previous contracts held for in-home oxygen and ventilator services. Details requested include the contract number, services provided, geographic locations, dates of performance, number of patients served, and a reference contact. The federal contract opportunity is a solicitation from the Department of Veterans Affairs for in-home oxygen and ventilator services for the Phoenix and Northern Arizona VA health care systems. Offerors are to respond by the date listed in the attached RFP and provide references using the worksheet attachment to demonstrate relevant experience for Factor 1 of the evaluation.
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Text version
Attachment D.1 – 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 |
| (examples: Molina Healthcare, VA Long Beach Healthcare system, VISN 22 |
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
| In what geographic location the Offeror performed these services |
| (example: Los Angeles and Orange counties) |
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 .