Atch_3_PP_References.doc

DOC document 41 KB Posted

Attached to
Patient Appointment Services Federal contract opportunity
Solicitation number
FA3010-18-R-0002
Issued by
Department of the Air Force Air Education and Training Command

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Revised References document

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Attachment 3-List of References

Solicitation #: FA3010-18-R-0002 Patient Appointment Services

PAST PERFORMANCE LIST OF REFERENCES

Company Name:________________________________

CONTRACT NUMBER

(include task order number(s) if applicable)

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)

CONTRACTING AGENCY POC/CUSTOMER NAME, PHONE # & EMAIL

CONTRACT VALUES

(include total contract amount, annual amount and POP for annual amount) performed by a proposed subcontractor, affiliate, or joint venture?

(If yes, please complete Page 2)

Total: $

Annual: $

POP for Annual:

Total: $

Total: $

CONTRACT NUMBER

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

DESCRIBE FUNCTION/TASK/3rd party affect on performance

1. If proposing to use a Subcontractor, Affiliate, or Joint Venture for this effort, include percentage of work, splitting of cost, type of services i.e. accounting, recruiting, etc they will perform for this effort (provide information below)

2. If contractor proposing on this effort provided past performance they performed as a Subcontractor, Affiliate, or Joint Venture, include percentage of work, splitting of cost, type of services performed, i.e. accounting, recruiting, etc for that effort (provide information below)

1.

2.

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