D.4 Past Performance Contacts.docx
DOCX document 99 KB Posted
- Attached to
- G004--2023 HCHV CERS Acquisition, Columbia MO
- Solicitation number
- 36C25523R0060
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Text version
Offeror: _____________________ Past Performance Survey
Provide a minimum of three current/past performance references below for Health Care for Homeless Veteran (HCHV) services conducted within the past three years, to include the names and phone numbers of responsible individuals who would have firsthand knowledge of the performance. The Government reserves the right to review other past performance records. Records found with unsubstantiated unsatisfactory past performance history may assess the offer as technically unacceptable.
Business Name: _____________________________________________________________
Business Address: ___________________________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contact Person Email:________________________________________________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contact Person Email:________________________________________________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contact Person Email:________________________________________________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
| Past Performance Survey |
| Page 1 of 1 |
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