D.3+Reference+Contract+Worksheet+Home+O2.docx

This is a reference contract worksheet template that offerors must complete as part of their response to Factor 1 - Experience for the solicitation titled "6515--3 Station In-Home Oxygen and In-Home Ventilation Services" issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 under solicitation number 36C25626R0037. The worksheet requires offerors to document their relevant experience by providing detailed information about reference contracts they have performed.

For each reference contract submission, offerors must supply the contract number, the legal name of the contracting entity, specification of whether services included in-home oxygen, in-home ventilator, or both, and a detailed description of specific tasks performed. Additional required information includes the geographic location where services were delivered, contract performance dates, patient volume data broken out separately for in-home oxygen and in-home ventilator services on a monthly basis, clarification of whether the reference work was performed directly by the offeror or a proposed subcontractor, and identification of whether the offeror or subcontractor served as prime or subcontractor. Finally, offerors must provide contact information (name, phone, and email) for a reference point at the contracting entity who can verify the information provided in the narrative description.