RFP ATTACHMENT 2 - REFERENCE INFORMATION SHEET - SUMMARY DATA TEMPLATE.pdf

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Medical Accession Services
Solicitation number
W81K0425RA016
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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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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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