D.7 PAST PERFORMANCE REFERENCES.docx
DOCX document 16 KB Posted
- Solicitation number
- 36C25623R0009
About this file
This document contains a past performance reference template for a federal contractor to submit references from previous government or commercial contracts, as well as information on an emergency department physician services solicitation.
The past performance reference template requests information on three previous contracts, including the client name and address, contract number, brief description of work performed, whether the offeror served as a prime contractor or subcontractor, dates of performance, total contract value, and any contract terminations for default. It also includes fields for points of contact and optional comments.
The federal contract opportunity is a solicitation by the VA Network Contracting Office 16 to identify vendors capable of providing a pool of board certified emergency medicine physicians to staff the emergency department at the G.V. (Sonny) Montgomery VA Medical Center in Jackson, MS, 24 hours a day 7 days a week. The opportunity type is a solicitation, and additional documents related to questions and answers, a re-solicitation notice, and a revised solicitation have been posted. The contracting agency is the VA's Veterans Health Administration VISN 16.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25623R0009 0005.pdf | ||
| 36C25623R0009 0004.docx | DOCX document | |
| 36C25623R0009 0003.docx | DOCX document | |
| D.3 E-verify Job Aid.pdf | ||
| D.12 SMALL BUSINESS SUBCONTRACTING PLAN-CERTIFICATION.pdf | ||
| D.8 PAST PERFORMANCE QUESTIONNAIRE.rtf | RTF text file | |
| D.5 Organizational Conflict of Interest.docx | DOCX document | |
| D.1 Quality Assurance Surveillance Plan (QASP)KT signed.pdf | ||
| D.11 INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| D.4 Medical Staff Bylaws Rules and Regulations Jackson VAMC 3.30.21 (1).pdf | ||
| D.2 SAM.gov User Guide.pdf | ||
| D.13 SUBCONTRACTING PLAN MODEL.docx | DOCX document | |
| D.9 INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| 36C25623R0009_v2.docx | DOCX document | |
| D.10 FREQUENTLY ASKED QUESTIONS.docx | DOCX document | |
| D.6 Immigration and Nationality.docx | DOCX document |
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Text version
Attachment D.7 – 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:
File details come from the government source that posted it. Updated .