RFP Attachment IV Past Performance Information Form.docx

DOCX document 50 KB Posted

Attached to
Vaccination Support Services Federal contract opportunity
Solicitation number
70RDAD22R00000002
Issued by
Department of Homeland Security Office of Procurement Operations

About this file

This document contains an attachment to be completed by quoters responding to a request for proposal for vaccination support services. The attachment requests information on up to three relevant past performance references, including customer and contracting contact details, contract numbers, types and values, dates, descriptions of work performed and relevance to the requirements of the solicitation. The related federal contract opportunity is a request for proposal from the Department of Homeland Security Office of Procurement Operations to establish multiple award indefinite delivery/indefinite quantity contracts for a variety of vaccination solutions to assist in vaccinating multiple populations. The contracts will be used to procure vaccines and vaccination services for authorized purposes using available appropriations.

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Text version

Attachment IV Past Performance Information Form

(Quoters are required to complete this form for no more than three (3) separate relevant contracts/projects)

Quoter:

Company Group / Division:

Program, Project, Or Task Title:

REFERENCE INFORMATION

1
Customer Name:
2
Address:
Customer Info:
Contracting Contact
Program / Project Manager or COR
3
Name & Title:
4
Organization:
5
Address:
5
Phone No.:
6
Fax No.:
7
E-mail:
8
Contract Number:
9
Contract Type (e.g. contract, BPA, task order) and pricing type (e.g. fixed price, cost reimbursement):
10
Dollar Value (Not-to Exceed):

Cumulative funded amount:

11
Project Start Date

Estimated/Actual Completion Date:

12
Current status, e.g. completed and/or in progress
13
If applicable, is this referenced contract finalized in CPARs?

Description of Work Performed and Relevance to Requirements in this RFQ

Problems Encountered and Resolutions

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