Attachment_2_Past_Performance_List_of_References_-_Inpatient_Pharmacists.doc

Attachment 2-List of References

Solicitation #: FA3010-16-R-0004

3 FTE Inpatient Pharmacists

PAST PERFORMANCE LIST OF REFERENCES

NUMBER

CONTRACT NUMBER

(include task order number(s) if applicable) performed by a proposed subcontractor, affiliate, or joint venture?

(If yes, please complete Page 2)

DESCRIPTION OF WORK PERFORMED

(performed as a prime/sub-contractor, details i.e. number of FTE, position type, full-time or session-based, etc. )

CONTRACT PERIOD OF PERFORMANCE (POP)

REFERENCE POINT OF CONTACT (POC)

(ref. should be person who received services i.e. CO, CA, COR, or equivalent if non-government)

REFERENCE POC PHONE

NUMBER & EMAIL

CONTRACT AMOUNT

(include total contract amount, annual amount and POP for annual amount)

Total: $

Annual: $

POP for Annual:

Total: $

Total: $

NUMBER

CONTRACT NUMBER

(include task order number(s) if applicable) subcontractor, affiliate, or joint venture

3rd party affect on performance (Provide role Subcontractor, Affiliate, or Joint Venture will play for this solicitation’s requirement. Include percentage of work, splitting of cost, type of services i.e. accounting, recruiting, etc.)