D.3 PAST PERFORMANCE REFERENCE3.doc

This is a Past Performance Reference form template used for the solicitation 36C25726Q0529 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17 for a Patient Elopement Installation project (VA-26-00064749).

The form is a standardized template designed to collect past performance information from contractors bidding on this opportunity. Section A requests general information including the contractor's name, address, relevant contract number, contract dollar value, contract period of performance (POP), and contact information for both the Contracting Officer's Technical Representative (COTR) and the Contracting Officer, including their respective phone numbers. Section B requests a detailed description of services performed under the referenced contract. The form serves as Attachment 36C25726Q0529 and is version 1.1. This template does not contain specific solicitation requirements, timelines, pricing terms, or other substantive contract details; rather, it is a blank form for offerors to submit documentation of their relevant past contract experience as part of their proposal evaluation.