RFP ATTACHMENT 2 - REFERENCE INFORMATION SHEET - SUMMARY DATA TEMPLATE.pdf
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- Attached to
- Medical Accession Services
- Solicitation number
- W81K0425RA016
- Issued by
-
Department of the Army Medical Command
About this file
This document is an Attachment 2 Reference Information Sheet template for submitting past performance references in a federal contract proposal. The template requires offerors to provide up to three Performance Assessment Submissions (PAS) that meet specific criteria: performance must have occurred within the last three years but not less than six months before the solicitation date, and can include work performed by the prime contractor or subcontractors performing at least 25% of proposed services.
The form allows companies to list contract references with details including contract number, SAM UEI number, whether work was performed as prime or subcontractor, and the method of past performance submission (either through CPARS or a questionnaire). Key restrictions include that only three total PAS can be submitted across prime and subcontractor teams, and if a Contractor Performance Assessment Report (CPAR) is already in the CPARS system, a separate questionnaire is not required. The template has sections for both the prime offeror and potential subcontractors to complete their performance reference information.
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Text version
ATTACHMENT 2 - REFERENCE INFORMATION SHEET
SUMMARY DATA
In accordance with the Addendum to 52.212-1 Instructions to Offerors - Commercial Products and Commercial Services, Volume III - Performance Risk Proposal (Past Performance) (Factor 2) may include no more than three (3) Performance Assessment Submissions (PAS). Each PAS shall meet the relevancy definition provided in the Addendum to 52.212-2, and performance must have occurred within the last three (3) years but not less than six (6) months of the solicitation date. The three (3) PAS may include work performed by the Prime Offeror and/ or Subcontractor(s), performing at least 25% of the services, stated in the Offeror's technical proposal.
Offeror: ________________________________________
Point of Contact:
Name: ________________________________________ Telephone: ________________________________________ Email Address: ________________________________________
Alternate Point of Contact:
Name: ________________________________________ Telephone: ________________________________________ Email Address: ________________________________________
In the table below, identify the contract references submitted for Past Performance evaluation.
Contract Number SAM UEI Number Performed Work As Method of Past Performance Submission
☐ Prime or ☐ Sub ☐ CPARS ☐ Questionnaire ☐ Prime or ☐ Sub ☐ CPARS ☐ Questionnaire
Note 1: If the Offeror’s Contractor Performance Assessment Report (CPAR) for the contract(s) referenced is located in the CPARS, it is not necessary for a Past Performance Questionnaire to be submitted.
Note 2. Only three (3) PAS may be provided. Offeror’s shall not submit three (3) PAS as the Prime Offeror and three (3) additional PAS for any Subcontractor(s).
ATTACHMENT 2 - REFERENCE INFORMATION SHEET
SUMMARY DATA
Subcontractor: ________________________________________
Point of Contact:
Name: ________________________________________ Telephone: ________________________________________ Email Address: ________________________________________
Alternate Point of Contact:
Name: ________________________________________ Telephone: ________________________________________ Email Address: ________________________________________
In the table below, identify the contract references submitted for Past Performance evaluation.
Contract Number SAM UEI Number Performed Work As Method of Past Performance Submission
☐ Prime or ☐ Sub ☐ CPARS ☐ Questionnaire
Note 3: If the Subcontractor’s CPAR for the contract(s) referenced is located in the CPARS, it is not necessary for a Past Performance Questionnaire to be submitted.
Note 4: Only three (3) PAS may be provided. Offeror’s shall not submit three (3) PAS as the Prime Offeror and three (3) additional PAS for any Subcontractor(s).
| 1: Insert Entity Name and SAM UEI Number |
| 2: Address Line 1 |
| 3: Address Line 2 |
| 4: Address Line 3 |
| 1_2: |
| 2_2: |
| Alternate Point of Contact: |
| 1_3: |
| 2_3: |
| 3_2: |
| Contract NumberRow1: |
| SAM UEI NumberRow1: |
| Prime or: Off |
| Sub: Off |
| CPARS: Off |
| Questionnaire: Off |
| Contract NumberRow2: |
| SAM UEI NumberRow2: |
| Prime or_2: Off |
| Sub_2: Off |
| CPARS_2: Off |
| Questionnaire_2: Off |
| Contract NumberRow3: |
| SAM UEI NumberRow3: |
| Prime or_3: Off |
| Sub_3: Off |
| CPARS_3: Off |
| Questionnaire_3: Off |
| SUMMARY DATA 1: Insert Entity Name and SAM UEI Number |
| SUMMARY DATA 2: Address Line 1 |
| SUMMARY DATA 3: Address Line 2 |
| SUMMARY DATA 4: Address Line 3 |
| 1_4: |
| 2_4: |
| Alternate Point of Contact_2: |
| 1_5: |
| 2_5: |
| 3_3: |
| Contract NumberRow1_2: |
| SAM UEI NumberRow1_2: |
| Prime or_4: Off |
| Sub_4: Off |
| CPARS_4: Off |
| Questionnaire_4: Off |
| Contract NumberRow2_2: |
| SAM UEI NumberRow2_2: |
| Prime or_5: Off |
| Sub_5: Off |
| CPARS_5: Off |
| Questionnaire_5: Off |
| Contract NumberRow3_2: |
| SAM UEI NumberRow3_2: |
| Prime or_6: Off |
| Sub_6: Off |
| CPARS_6: Off |
| Questionnaire_6: Off |
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