VA250-17-R-1170-003.docx

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VISN 10 Eyeglass Dispensing Services Northern Tier
Solicitation number
VA25017R1170
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VA250-17-R-1170 S02- Past Performance Contractor References.docx

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PAST PERFORMANCE CONTRACTOR REFERENCES

Offeror must list a minimum of three (3) and a maximum of five (5) past (within the last three (3) years) or current references with specific knowledge of offeror’s past performance similar to the requirements listed in this solicitation.

CONTRACTOR:

Reference 1:

Customer Name:____________________________________
Point of Contact & Email:____________________________________
Phone Number:____________________________________
Purchase Order/Contract #:____________________________________

Detailed Description of Services Provided:

Reference 2:

Customer Name:____________________________________
Point of Contact & Email:____________________________________
Phone Number:____________________________________
Purchase Order/Contract #:____________________________________

Reference 3:

Customer Name:____________________________________
Point of Contact & Email:____________________________________
Phone Number:____________________________________
Purchase Order/Contract #:____________________________________

Reference 4:

Customer Name:____________________________________
Point of Contact & Email:____________________________________
Phone Number:____________________________________
Purchase Order/Contract #:____________________________________

Reference 5:

Customer Name:____________________________________
Point of Contact & Email:____________________________________
Phone Number:____________________________________
Purchase Order/Contract #:____________________________________

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