S02 - ATTACHMENT D.2 - PAST PERFORMANCE QUESTIONNAIRE v2.pdf

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Q702--Onsite Sterile Processing Technician (SPS) Services MEDVAMC
Solicitation number
36C25622Q0130
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Attachment D.2 – Past Performance Questionnaire - 36C25622Q0130

Past Performance Questionnaire

Please list your contracts in the chronological order beginning with the most recent one.

Contracts shall be relevant to the Solicitation. Contracts listed cannot be more than 3 years old.

You can list ongoing contracts that began more than 3 years ago.

Contract #1

1. Customer Name 2. Customer’s Address

3. Name and Title of Point of Contact 4. Point of Contact’s Email Address

5. Point of Contact’s Phone Number 6. Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

___Ongoing ___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the

Solicitation documents. Attach separate sheet if additional space is needed.)

Contract #2

1. Customer Name 2. Customer’s Address

3. Name and Title of Point of Contact 4. Point of Contact’s Email Address

5. Point of Contact’s Phone Number 6. Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

___Ongoing ___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the

Contract #3

1. Customer Name 2. Customer’s Address

3. Name and Title of Point of Contact 4. Point of Contact’s Email Address

5. Point of Contact’s Phone Number 6. Estimated Contract Value

7. Contract Term (Month and Year)

From _______ through _______________

8. Contract Effective Date

9. Contract Status

___Ongoing ___Completed

10. Scope of Contract Requirements (Describe in details the scope of works performed under this contract as indicated in the

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