10. Past Performance Questionnaire.pdf

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Attached to
Line Fire BAER and Suppression Repair. San Bernardino National Forest. Federal contract opportunity
Solicitation number
127EAW25R0031
Issued by
Department of Agriculture Forest Service

About this file

Written by GovTribe AI ·

The document is an Experience Questionnaire for a federal contract opportunity related to guardrail replacement and suppression repair work on the San Bernardino National Forest. The questionnaire requires potential contractors to provide detailed information about their company's experience, including years of operation, past projects involving loading/unloading heavy equipment, key personnel qualifications, current contractual commitments, and references. Contractors must document their capabilities in working with cranes, handling precast concrete structures, and completing similar infrastructure repair projects within the last five years.

The questionnaire is part of the solicitation (No. 127EAW25R0031) for a project involving installing 205 feet of guardrail, 21 corrugated metal spillways, and resetting 3 spillways across Front Country and Mountaintop Ranger Districts. The contract is valued between $25,000-$100,000, has a projected start date of June 18, 2025, with a 105-calendar day completion timeline, and falls under NAICS code 237310 (Highway Street Bridge Construction). Davis-Bacon wages apply, and bonds are required for projects valued at $35,000 or above, with the work to be performed for the Department of Agriculture Forest Service.

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Experience Questionnaire

1. Contractor Name, Address, Telephone Number, and Email Address:

2. COMPANY INFORMATION

DUNS or UEI: __________________ Small Business: Yes No

Primary NAICS Code: _____________

3. How many years of experience do you or your company have in performing this work? _____________

4. Will you be using a subcontractor? Yes No

5. Please provide references for the last three (3) company where you performed

Company and Name of Person Email Address/Phone # Description of Work

6. Describe the equipment you will be using in the performance of this contract:

7. Do you have experience working with cranes to load/move heavy equipment? Yes____ No __________

8. What types of equipment do you have experience working with that is relevant to this contract?

9. List below the experience of the key personnel who will be performing the work:

Individual’s Name Present Position Years of Experience

Type of Work

10. Past Performance - List below the projects your business has completed within the last five (5) years that involved included loading and unloading of heavy equipment such as precast concrete structures/ vault toilets?

Contract Number

Contract Amount

Location of Work Names, Telephone No., and Email of Owner/Person to contact for Project Information

Description of Project

Location of Work

Location of work

11. List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract # Dollar Amount Name, Tel, Email of Business/Govt Agency Involved

Location of work When will contract be completed?

CERTIFICATION

I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons named as references are authorized to furnish the Government with any information needed to verify my capability to perform this project.

13a. CERTIFYING OFFICIAL'S NAME AND TITLE

13b. SIGNATURE 14. DATE

1 Contractor Name Address Telephone Number and Email Address:
DUNS or UEI:
Primary NAICS Code:
3 How many years of experience do you or your company have in performing this work:
5 Please provide references for the last three 3 company where you performed:
Company and Name of PersonRow1:
Email AddressPhone Row1:
Description of WorkRow1:
Company and Name of PersonRow2:
Email AddressPhone Row2:
Description of WorkRow2:
Company and Name of PersonRow3:
Email AddressPhone Row3:
Description of WorkRow3:
6 Describe the equipment you will be using in the performance of this contract 1:
6 Describe the equipment you will be using in the performance of this contract 2:
undefined:
undefined_2:
8 What types of equipment do you have experience working with that is relevant to this contract:
Individuals NameRow1:
Present PositionRow1:
Years of ExperienceRow1:
Type of WorkRow1:
Contract NumberRow1:
Contract AmountRow1:
Location of WorkRow1:
Names Telephone No and Email of OwnerPerson to contact for Project InformationRow1:
Description of Project:
Contract NumberRow1_2:
Contract AmountRow1_2:
Location of WorkRow1_2:
Names Telephone No and Email of OwnerPerson to contact for Project InformationRow1_2:
Description of ProjectRow1:
Description of Project_2:
Contract Row1:
Dollar AmountRow1:
Name Tel Email of BusinessGovt Agency InvolvedRow1:
Location of workRow1:
When will contract be completedRow1:
Contract Row2:
Dollar AmountRow2:
Name Tel Email of BusinessGovt Agency InvolvedRow2:
Location of workRow2:
When will contract be completedRow2:
Contract Row3:
Dollar AmountRow3:
Name Tel Email of BusinessGovt Agency InvolvedRow3:
Location of workRow3:
When will contract be completedRow3:
13a CERTIFYING OFFICIALS NAME AND TITLE:
13b SIGNATURE:
14 DATE:
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