D.29 PAST PERFORMANCE REFERENCES.docx
DOCX document 16 KB Posted
- Attached to
- Q201--Copy of Meridian CBOC
- Solicitation number
- 36C25623R0002
About this file
This document contains a past performance reference template for a federal contractor to submit with their proposal. The template requests information on up to three past or current government or commercial contracts, including: contract number, brief description of work, whether the offeror performed as a prime contractor or subcontractor, dates of performance, total contract value, and any terminations for cause or default disputes. For each reference, it asks for a point of contact including their name, title, phone number, email, and optional comments.
The related federal contract opportunity is a solicitation from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 for project Q201, copying an existing Meridian Community Based Outpatient Clinic. No further details are provided on the required products or services, response deadline, or award date.
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Text version
Attachment D.29 – Past Performance References
Reference 1:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
Reference 2:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
Reference 3:
Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:
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