WCMBP_Section_J_Attachment_11_-_Past_Perf_Ref_List_Template_AMD_5.doc
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United States Department of Labor
(DOL)
Workers’ Compensation Medical Bill Process (WCMBP)
Attachment 11 –
Past Performance Reference List Template December 30, 2013 Office of Workers’ Compensation Programs (OWCP)
Past Performance Project Reference List Offeror: _____________________
| Unique Project Identifier |
| Project Name |
| Involvement |
| Total Value |
| Period of Performance |
| Use the format: PPnnnn, where ‘nnnn’ is a sequentially increasing integer, starting with “PP0001” |
| Identify the project name |
| Indicate if Prime or Subcontractor, and percentage of work performed |
| Indicate the $ value of the contract |
| Indicate the start date and end date (if complete) of the contract |
(The shaded row can be removed when the list is created) The offeror can cite no past or ongoing projects that provide relevant past performance to this proposal
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