D.9 PAST PERFORMANCE REFERENCES.docx
DOCX document 21 KB Posted
- Attached to
- Q402--Community Nursing Home Services - Arkansas
- Solicitation number
- 36C25623Q1275
About this file
This document contains a past performance reference template for a federal contractor to submit references from previous government or private contracts.
The template requests information on three past performance references, including the name and address of the contracting organization, contract number, brief description of work performed, whether the contractor served as a prime or subcontractor, dates and value of the contract, and any contract terminations for cause or filed discrepancy reports. For each reference, it asks for a point of contact including their name, title, phone number, email, and additional comments.
The related federal contract opportunity is for community nursing home services in Arkansas under solicitation number 36C25623Q1275 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The template appears to be for contractors to submit with proposals or bids in response to this opportunity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| D.2 SAM.gov User Guide.pdf | ||
| D.8 ORGANIZATIONAL CONFLICTS OF INTEREST.docx | DOCX document | |
| D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP).pdf | ||
| D.5 WAGE DETERMINATIONS.docx | DOCX document | |
| 36C25623Q1275.docx | DOCX document | |
| D.3 E-verify Job Aid.pdf | ||
| D.7 IMMIGRATION AND NATIONALITY.docx | DOCX document | |
| D.10 SMALL BUSINESS SUBCONTRACTING PLAN CERTIFICATION.pdf | ||
| D.4 (VA) COMMUNITY NURSING HOME PROGRAM LEVEL OF CARE.pdf | ||
| D.6 TECHNICAL CAPABILITY CHECKLIST.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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