Atch_2._PPI_reference_list_as_of_physician.doc

FA5209-16-R-0014

Attachment 2

PAST PERFORMANCE REFERENCE LIST

CHILD PSYCHOLOGIST FOR 374TH MEDICAL GROUP, YOKOTA AIR BASE, JAPAN

1. Name of contracting activity ( Customer’s name)

2. Name and title of point of contact (POC); Contracting Officer or/and Government Inspector/commercial project manager’s phone/Fax number, and e-mail address

Tel:

Fax:

e-mail:

3. Contract number and project title

4. Contract Type (e.g. Firm-Fixed Price, IDIQ, Requirements type)

5. Total contract value (Annual ) and (aggregated)

6. Performance period (e.g. date/month/year through date/month/year)

7. Description of contract work performed

Details (Is child treatment included? Descrive the details as much as possible.)

8. Contracting Officer’s name and phone number

9. Government Inspector/commercial project manager and phone number

10. List of major subcontractors if applicable

OFFEROR’S NAME: _______________________________________________________________