RFP ATTACHMENT 3 - REFERENCE INFORMATION SHEET - CONTRACT SPECIFIC DATA TEMPLATE.pdf
PDF 1 MB Posted
- Attached to
- Medical Accession Services
- Solicitation number
- W81K0425RA016
- Issued by
-
Department of the Army Medical Command
About this file
Attachment 3 is a Reference Information Sheet template for contract-specific data, designed to be completed by offerors when providing past performance references for a federal solicitation. The three-page form requires detailed information about previous contract work, including:
Key elements include spaces to document contract details such as contract dates, contract type, initial and final contract amounts, current contract status, and technical/contracting points of contact. The template also requires offerors to provide contract-specific technical capabilities data as outlined in FAR Provision 52.212-1 and 52.212-2, with instructions to elaborate on technical capabilities without altering font, size, or creating additional narrative space. This document is part of the pre-solicitation process for the Medical Accession Services contract (Solicitation W81K0425RA016), which will be an 8(a) set-aside Indefinite Delivery/Indefinite Quantity (IDIQ) contract for medical evaluation services at military entrance processing stations.
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Text version
ATTACHMENT 3 - REFERENCE INFORMATION SHEET
CONTRACT SPECIFIC DATA
(Reproduce This Form For Each Contract Reference Cited On Attachment 2)
1. Offeror: ________________________________________
2. Reference Contract, Order, or other Control Number: ________________________
3. Contract Title/ Information: _____________________________________________
a. Date of Contract: _________________
b. Date Work Began: _________________
c. Date Work Was Completed: _________________
d. Contract Type: ____________________________
e. Initial Contract Amount (Total Ceiling): _________________
f. Final (or Current) Contract Amount: _________________ (Total Ceiling) (if different from Initial): _________________
4. Has a Performance Risk Assessment Questionnaire Been Requested from the
Technical and/or Contracting Point of Contact for this Reference. ☐ Yes ☐ No
Date of Request: _________________
5. Technical Point of Contact for this Reference:
Name: ____________________________________________ Telephone #: ____________________________________________ Email: ____________________________________________
6. Contracting Point of Contact for this Reference:
Name: ____________________________________________ Telephone #: ____________________________________________ Email: ____________________________________________
7. Current Status of Contract (Choose One):
☐ Work continuing, on schedule ☐ Work continuing, behind schedule ☐ Work completed, no further action pending or underway ☐ Work completed, routine administrative ☐ Work completed, claim negotiations pending or underway ☐ Work completed, litigation pending or underway ☐ Terminated for Convenience ☐ Terminated for Default ☐ Other (explain)
Provide contract specific technical capabilities data required in FAR Provision 52.212-1 for the evaluation criteria identified in FAR Provision 52.212-2.
Continuation: Contract specific technical capabilities data required in FAR Provision 52.212-1 for the evaluation criteria identified in FAR Provision 52.212-2.
| 1 Offeror 1: Insert Entity Name and SAM UEI Number |
| 1 Offeror 2: Address Line 1 |
| 1 Offeror 3: Address Line 2 |
| 1 Offeror 4: Address Line 3 |
| 2 Reference Contract Order or other Control Number: Insert Identifying Number |
| 3 Contract Title Information: |
| 1: |
| 2: |
| c Date Work Was Completed: |
| e Initial Contract Amount Total Ceiling: |
| Final or Current Contract Amount: |
| Total Ceiling if different from Initial: |
| Technical andor Contracting Point of Contact for this Reference: Off |
| Date of Request: |
| 5 Technical Point of Contact for this Reference: |
| Telephone 1: |
| Telephone 2: |
| undefined: |
| Telephone 1_2: |
| Telephone 2_2: |
| Work continuing on schedule: Off |
| Work continuing behind schedule: Off |
| Work completed no further action pending or underway: Off |
| Work completed routine administrative: Off |
| Work completed claim negotiations pending or underway: Off |
| Work completed litigation pending or underway: Off |
| Terminated for Convenience: Off |
| Terminated for Default: Off |
| Other explain: Off |
| Text1: You may use this text box to elaborate on the current status of the contract cited for this Reference Information Sheet - Contract Specific Data only. Offerors shall not alter this form to adjust font, font size, or other features to create additional narrative space. Elaborate formats, tables, or color presentations are not desired or required. |
| Text2: You may use this text box to elaborate, or provide a synopsis of how the technical capabilities of the work performed for the contract reference cited for this Reference Information Sheet - Contract Specific Data only correlate to the work required under this solicitation. Offerors shall not alter this form to adjust font, font size, or other features to create additional narrative space. Elaborate formats, tables, or color presentations are not desired or required. |
| Text3: You may use this text box to elaborate, or provide a synopsis of how the technical capabilities of the work performed for the contract reference cited for this Reference Information Sheet - Contract Specific Data only correlate to the work required under this solicitation. Offerors shall not alter this form to adjust font, font size, or other features to create additional narrative space. Elaborate formats, tables, or color presentations are not desired or required. |
| Dropdown4: [] |
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