Attachment 09B_Reference Information Sheet_Contract Specific Data_Template.pdf
PDF 5 MB Posted
- Attached to
- Air Force Drug Testing Laboratory Support Services Federal contract opportunity
- Solicitation number
- FA805220R0001
About this file
This solicitation is for support services at the Air Force Drug Testing Laboratory. The services required include nineteen full time equivalents across five labor categories: two Medical Laboratory Technician-Team Leads, eight Medical Laboratory Technicians for specimen processing, four Data Entry Clerks, two Analytical Scientists, and three Information Technology Support personnel. The place of performance is Joint Base San Antonio-Lackland, Texas. The services will support the Department of Defense Drug Demand Reduction Program at one of its six drug testing laboratories. The period of performance and response deadline are not specified.
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Text version
ATTACHMENT _____ - REFERENCE INFORMATION SHEET - CONTRACT SPECIFIC DATA
SOLICITATION # ____________________
(Reproduce this form for each Contract Reference Cited)
1. Contract Number/Task Order Number or other Control Number: _____________________________
2. Complete Name and Address of Contract Reference:
3. Contract Title/Information: __________________________________________________________
a. Date of Contract: _______________________________________________________________
b. Date work began: ______________________________________________________________
c. Date work was completed: _______________________________________________________
d. Contract Type: ________________________________________________________________
e. Initial Contract Amount (Total Ceiling): _____________________________________________
f. Final (or Current) Contract Amount
(Total Ceiling) (if different from Initial): _____________________________________________
4. Technical Point of Contact for this Reference:
Name: __________________________________________________________________________
Telephone #: _________________________
Email: __________________________________________________________________________
5. Contracting Point of Contact for this Reference:
Name: __________________________________________________________________________
Telephone #: _________________________
Email: __________________________________________________________________________
6. Location of work (country, state or province, county, city): _________________________________
ATTACHMENT _____ - REFERENCE INFORMATION SHEET - CONTRACT SPECIFIC DATA
SOLICITATION # ____________________
7. Current status of contract (choose one):
Work continuing, on schedule
Work continuing, behind schedule
Work completed, no further action pending or underway
Work completed, routine administrative
Work completed, claims negotiations pending or underway action pending or underway
Work completed, litigation pending or underway
Terminated for Convenience
Terminated for Default
Other (explain)
8. Provide contract specific technical capabilities data required in FAR Provision 52.212-1 for the evaluation criteria identified in FAR Provision 52.212-2.
| Date of Contract: 01/01/2020 |
| Contract Type: Insert Contract Type (i.e. Firm-Fixed-Price, Cost, Time & Materials) |
| Work continuing on schedule: Off |
| Work continuing behind schedule: Off |
| Work completed no further action pending or underway: Off |
| Work completed routine administrative: Off |
| Work completed claims negotiations pending or underway action pending or underway: Off |
| Work completed litigation pending or underway: Off |
| Terminated for Convenience: Off |
| Terminated for Default: Off |
| Other explain: Off |
| Identifying Number: Insert Identifying Number |
| Reference Company Name: Insert Reference Company Name |
| Reference Company Address Line 1: Insert Reference Company Address, Line 1 |
| Reference Company Address Line 2: Insert Reference Company Address, Line 2 |
| Contract Title or Description: Insert Brief Title or Description |
| Date Work Was Completed: 01/01/2020 |
| Initial Contract Amount: Insert Initial Contract Value |
| Final Contract Amount: Insert Final Contract Value |
| Technical POC Email: Insert Technical POC Email |
| Contracting POC Name: Insert Contracting POC Name |
| Contracting POC Email: Insert Contracting POC Email |
| Location: Insert Performance Location |
| Attachment Number: 09B |
| Solicitation Number: FA8052-20-R-0001 |
| Text Box: |
| Technical POC Name: Insert Technical POC Name |
| Technical POC Telephone: Insert Technical POC Name |
| Contracting POC Telephone: Insert Contracting POC Name |
| Date Work Began: 01/01/2020 |
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