D.1 Reference Contract Worksheet RRT Polysomn.docx

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Attached to
Registered Respiratory Therapist Staffing Services
Solicitation number
36C26226Q0285
Issued by

About this file

This is a reference contract worksheet template designed for offerors responding to a solicitation for Registered Respiratory Therapist (RRT) staffing services with the VA Greater Los Angeles Healthcare System. The worksheet requires offerors to document their relevant experience by providing details about prior contracts held with government entities, including information about whether the work involved providing RRT staffing services, RRT with Polysomnographer staffing services, or both. Offerors must describe the specialized experience gained, specify the geographic locations where services were performed, provide contract dates, and clarify their role as either prime contractor or subcontractor. Additionally, offerors must supply verification contact information from the contracting entity to validate the information presented.

The worksheet is part of the technical evaluation criteria (Factor 1 - Experience) for solicitation number 36C26226Q0285 and requires offerors to complete a separate worksheet for each reference contract being cited. This template ensures consistent documentation of relevant experience and allows the government to verify the qualifications and performance history of offerors competing for the RRT staffing services contract with the Department of Veterans Affairs Veterans Integrated Service Network 22.

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Other files

File Type Posted
36C26226Q0285 0002 Amendment RRT RFQ.docx DOCX document
36C26226Q0285 0001 Amendment RRT RFQ.docx DOCX document
36C26226Q0285 Revised RFQ.docx DOCX document
D.2 Price Worksheet RRT Polysomn.docx DOCX document
D.3 Wage Determination 2015-5613.pdf PDF
36C26226Q0285.docx DOCX document

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D.1 REFERENCE CONTRACT WORKSHEET FOR OFFEROR’S RESPONSE TO FACTOR 1 – EXPERIENCE

Reference Contract #__

The legal name of entity with whom the Offeror (or Offeror’s proposed subcontractor) held the contract
(example: Veterans Affairs, VISN 22)

Contract Number

State below whether the contract was for:

1) Providing Registered Respiratory Therapist (RRT) Staffing Services. Yes/No?

AND/OR

2) Providing RRT with Polysomnographer Staffing Services. Yes/No?

Provide a description below with details of the specific tasks the Offeror (or the Offeror’s proposed subcontractor) performed under that Contract. Include the following: (1) Specialized Experience in providing RRT Staffing Services. (2) Specialized Experience providing RRT with Polysomnographer Staffing Services. Please also reference the Instructions to Offerors section of the RFQ under Factor 1 (Technical) – Experience.

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

Whether the Offeror or its proposed subcontractor was the prime contractor or a subcontractor for this 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 .