Past_Performance_List_of_References-_Atch_3.pdf

Attachment 3-List of References Solicitation #: FA301017R0035

1 FTE Medical Office Admin Clerk - Urology

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, %performed, 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:

Attachment 3-List of References Solicitation #: FA301017R0035

1 FTE Medical Office Admin Clerk - Urology

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.)