S14 Attachment 5 - Past Performance Info (86615625R00005).docx

This is a Past Performance Information form requiring submission of relevant services performed during the three years prior to proposal submission for solicitation 86615625R00005.

The form requests documentation of contractor experience through a structured template requesting prime contractor or subcontractor name, client name, point of contact information, type of services provided, contract number and value, dates of service, and principal partners or key personnel involved. The example provided demonstrates a Technical Assistance contract with the HUD Office of Public and Indian Housing (PIH) valued at $1,000,000, performed from January 2007 to January 2009 under contract C-DEN-12345. The listed key personnel included John Smith as Project Manager, Jane Doe as TA Specialist, and John Smith Jr as Accounting Specialist. The point of contact was identified as John Doe at the PIH Office of Technical Assistance in Washington, DC. Contractors must indicate whether Past Performance Information Reports (PPIRs) are on file. This attachment is part of the Office of Healthcare Programs hospital assessment services solicitation, with proposals due March 19, 2026 at noon ET and questions due February 26, 2026 at noon ET.