D.9 PAST PERFORMANCE REFERENCES.docx
DOCX document 21 KB Posted
- Attached to
- Q402--Community Nursing Home Services - Arkansas
- Solicitation number
- 36C25623Q1275_1
About this file
This document contains a past performance reference template for a federal contractor to submit with their proposal. It requests information on up to three past or current contracts including the client name and address, contract number, brief description of work performed, role as prime or subcontractor, dates and value of the contract, and potential issues.
The template collects details on the contractor's past performance such as whether contracts were terminated for cause, any filed contract discrepancy reports, and points of contact from the client including name, title, phone, email and additional comments. This past performance information template is to be included in proposals for solicitation number 36C25623Q1275_1 issued by the Department of Veterans Affairs for community nursing home services in Arkansas. Proposers will need to demonstrate relevant and successful past performance on similar federal contracts to be competitive for this award.
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Other files
| File | Type | Posted |
|---|---|---|
| D.8 ORGANIZATIONAL CONFLICTS OF INTEREST.docx | DOCX document | |
| D.5 WAGE DETERMINATIONS.docx | DOCX document | |
| D.6 TECHNICAL CAPABILITY CHECKLIST.pdf | ||
| 36C25623Q1275.docx | DOCX document | |
| D.4 (VA) COMMUNITY NURSING HOME PROGRAM LEVEL OF CARE.pdf | ||
| D.10 SMALL BUSINESS SUBCONTRACTING PLAN CERTIFICATION.pdf | ||
| D.3 E-verify Job Aid.pdf | ||
| D.7 IMMIGRATION AND NATIONALITY.docx | DOCX document | |
| D.2 SAM.gov User Guide.pdf | ||
| D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP).pdf |
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Text version
Attachment D.9 – 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:
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