D.8 PAST PERFORMANCE REFERENCES.docx

29 KB Posted

Attached to
Electric Cart Washer to include deinstalling (old)/site prep & installing new)
Solicitation number
36C25726Q0435
Issued by

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This is a Past Performance References form template for solicitation 36C25726Q0435 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17. The form requests contractors to provide three past performance references demonstrating relevant experience with similar work. Each reference requires documentation of the client organization name and address, contract number, and a brief description of work performed, along with specification of whether the contractor served as prime or subcontractor and the contract performance dates and total value.

The template mandates disclosure of any terminations for cause or default and any filed contract discrepancy reports, with explanations required if applicable. Additionally, contractors must provide complete point of contact information for each reference, including the Government Contracting Officer's Representative (COR) or equivalent, their title, phone number, and email address, with space for comments. This form is ancillary to the primary solicitation for providing an electric cart washer system including deinstallation of existing equipment, site preparation, delivery, installation, safety checks, and testing.

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Other files

File Type Posted
36C25726Q0435 0002.docx DOCX document
S06_36C25726Q0435 0001 .pdf PDF
D.1 STATEMENT OF WORK_ Cart Washers.pdf PDF
D.2 APPENDIX A - SAFETY REQUIREMENTS.pdf PDF
D.3 APPENDIX B - GENERAL REQUIREMENTS.pdf PDF
D.6 APPENDIX E Infection Control Risk Assessment ICRA_2_Redacted.pdf PDF
S02_36C25726Q0435.pdf PDF
D.5 APPENDIX D Pre-Construction Risk Assessment PCRA_Redacted.pdf PDF
D.7 WAGE DETERMINATIONS - TX20260236.pdf PDF
D.4 APPENDIX C - AAMI ST 108.pdf PDF

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D.8 ATTACHMENT 36C25726Q0435 – PAST PERFORMANCE REFERENCES

REFERENCE 1:

Name of Government or Commercial Organization: Address:

Contract Number:

Brief Description:

Contractor Performed as (check one): Prime ContractorSub-Contractor
Dates of Performance (if current include expiration):Total Value of Contract:

Any terminations for cause or default? Circle YES or NO

If yes, brief explanation:Any contract discrepancy reports filed? Circle YES or NO
If yes, brief explanation:Point Of Contact/COR:
Title:Telephone Number:

Point of Contact’s email address:

Comments:

REFERENCE 2:

Name of Government or Commercial Organization: Address:

Contract Number:

Brief Description:

Contractor Performed as (check one): Prime ContractorSub-Contractor
Dates of Performance (if current include expiration):Total Value of Contract:

Any terminations for cause or default? Circle YES or NO

If yes, brief explanation:Any contract discrepancy reports filed? Circle YES or NO
If yes, brief explanation:Point Of Contact/COR:
Title:Telephone Number:

Point of Contact’s email address:

Comments:

REFERENCE 3:

Name of Government or Commercial Organization: Address:

Contract Number:

Brief Description:

Contractor Performed as (check one): Prime ContractorSub-Contractor
Dates of Performance (if current include expiration):Total Value of Contract:

Any terminations for cause or default? Circle YES or NO

If yes, brief explanation:Any contract discrepancy reports filed? Circle YES or NO
If yes, brief explanation:Point Of Contact/COR:
Title:Telephone Number:

Point of Contact’s email address:

Comments:

File details come from the government source that posted it. Updated .