S02 D.2 PAST PERFORMANCE CONTRACTS.pdf
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- Cancer Registrar Contract Services
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- 36C25522Q0114
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Attachment D.2 36C25522Q0114 Offeror: _____________________
Past Performance Survey
Past Performance Survey
Provide a minimum of three current/past performance references below for hemodialysis services conducted within the past three years, to include the names and phone numbers of responsible individuals who would have firsthand knowledge of the performance. The Government reserves the right to review other past performance records. Records found with unsubstantiated unsatisfactory past performance history may assess the offer as technically unacceptable.
Business Name: _____________________________________________________________
Business Address: ___________________________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Business Name: _____________________________________________________________
Business Address: ___________________________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
Business Name: _____________________________________________________________
Business Address: ___________________________________________________________
Contact Person: ___________________________ Title: ____________________________
Telephone Number: _________________________ Contract Value: $__________________
Contract Number/Reference: ___________________________________________________
Contract Period of Performance Dates: ___________________________________________
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