12443924Q0054 Experience and Past Performance Questionnaire.pdf
PDF 129 KB Posted
- Solicitation number
- 12443924Q0054
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Experience and Past Performance Questionnaire for a federal contract opportunity. The key details are:
The solicitation is for the Daniel Boone National Forest (DBNF) Cumberland Ranger District - Fern Bluff Work Center Roof System Replacements, Solicitation Number 12443924Q0054, issued as a Request for Quotation (RFQ) under FAR Part 12 procedures. The Government anticipates award of a firm fixed-price contract. This is a 100% small business set-aside under NAICS code 236220, with a $45M or less average annual receipts requirement. The Davis-Bacon Act applies.
The questionnaire requests information on the contractor's business type, years of experience, current contract commitments, past performance, and personnel and equipment resources. Contractors must be registered in the SAM system and not debarred. Offers must be submitted electronically by the deadline.
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Text version
EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE
Instructions: Use Item No. 10 Remarks if extra space is needed to answer any item below. Answer all items.
1. Contractor’s Name, Address & Telephone Number.
2. Type of Business
___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization
3. How many years’ experience do you have in this Line of work? ____ Years
4. How many years’ experience as a Prime Contractor?
_____ Years
Subcontractor? _____ Years
5. List the projects your business has completed in the last three (3) years.
COMPANY NAME,
ADDRESS , TELEPHONE
NUMBER AND CONTACT
PERSON
CONTRACT TYPE/PROJECT
DESCRIPTION
CONTRACT
AMOUNT
PERIOD OF
PERFORMANCE/DATE
COMPLETED
1. List all of your firms’ current contract commitments.
CONTRACT
NUMBER
AWARD
AMOUNT
Contact Name, Address & Telephone Number
Percent Completed
Date Contract Completed
7a. Have you ever failed to complete any work awarded to you? ___Yes ___No
7b. Has work ever been completed by performance bond? ___Yes ___No
7c. If “Yes” to either item 7a or 7b above, specify reason(s) and location(s) why.
8. Organization structure that will be available for this project:
a. Minimum No. of employees: _____ and Maximum No. of employees: _____
b. Are employees regularly on your payroll? ___Yes ___No
c. Specify equipment available for this contract:
d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc…):
Minimum progress rate: ____________ Maximum progress rate: ____________
9. List the experience of the principal individuals of your business
NAME PRESENT POSITION YEARS
EXPERIENCE
TYPE OF WORK
10. REMARKS
CERTIFICATION: I certify that all of the statements made by me are complete and correct to be best of my knowledge and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
Signature Print or Typed Name Title Date
Duns # _______________ Tax ID# ______________ Currently Registered in SAM? [ ] Yes or [ ] No
File details come from the government source that posted it. Updated .