127EAT23Q0048 Attachment C Past Performance Questionnaire.pdf
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- Solicitation number
- 127EAT23Q0048
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a past performance questionnaire for solicitation number 127EAT23Q0048 from the USDA Forest Service seeking past performance information from offerors for the delivery of high density polyethylene (HDPE) timbers to the Chantry Flat Recreation Area. The questionnaire requests information on the offeror's experience, including the number of years in the relevant line of work and contracting experience as a prime contractor and subcontractor. Offerors are asked to provide details on two similar projects completed in the last three years, including contract amounts, project types, completion dates, and points of contact. The questionnaire also inquires about any past failures to complete work and requires certification that responses are complete and accurate.
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Text version
Solicitation 127EAT23Q0048 High Density Polyethylene (HDPE) Timbers
USDA – Forest Service
PAST PERFORMANCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
2. SUBMITTED TO (office Name and Address)
3. BUSINESS
Company Co-partnership Corporation Individual Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years of experience in contracting have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below two (2) projects your business has completed delivering similar equipment within the last three years:
CONTRACT
AMOUNT
TYPE OF PROJECT
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7a. Have you ever failed to complete any work awarded to you? Yes No 7b. If “Yes” to Item 8a type of project and reason(s) why:
8. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
9a. CERTIFYING OFFICIAL’S NAME AND TITLE
b. SIGNATURE (Sign in ink) 10. DATE
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