HT001125R0011 Atch E Subcontractor Past Performance Consent.pdf
PDF 140 KB Posted
- Attached to
- Primary Care Behavioral Health Expert Trainers
- Solicitation number
- HT001125R0011
- Issued by
-
Defense Health Agency
About this file
The document is a Subcontractor Past Performance Consent Form for Solicitation HT001125R0011, which allows a subcontractor to consent to performance reference exchanges between the company and the Defense Health Agency (DHA). The form enables communication about past performance evaluations and references submitted with a proposal for the Primary Care Behavioral Health Expert Trainer Support procurement.
The related federal contract opportunity is an 8(a) set-aside solicitation for providing Primary Care Behavioral Health mentoring and training services. The contract will be a Firm Fixed-Price award for 60 months (12-month base period with four 12-month option periods, plus potential 6-month extension), supporting DHA's Medical Affairs division. Key services include clinical advisory support, training development, mentorship of Behavioral Health Consultants, Military Treatment Facility implementation support, and delivering services remotely across the United States. The principal objective is ensuring compliance with specific Department of Defense instructions and healthcare standards. Vendor questions are due by March 17th, 2025, at 4:00 pm.
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Text version
HT001125R0011, Attachment E
SUBCONTRACTOR PAST PEFORMANCE CONSENT FORM
Subject: Request for Proposal (RFP) HT001125R0011 for Primary Care Behavioral Health Expert Trainer Support
_______________________________________ is participating as a to _______________________________________ in responding to the Request For Proposal HT001125R0001 for Defense Health Agency (DHA) Health Care Operations and Other Program Support.
_______________________________________ consents to exchanges between DHA and _______________________________________ concerning evaluation of the company’s past performance references submitted with the proposal or evaluation of recent past performance information from other sources. Exchanges may include clarifications concerning past performance relevance or other communications concerning adverse past performance information.
SIGNATURE:
jkelley2 Cross-Out
| Dropdown1: [subcontractor] |
| Company Name: [Company Name] |
| Prime Name: [Prime Offeror Name] |
| Name: [Signer Name] |
[Signer Title] [Signer Address]
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