Attachment 3 Past Performance Questionnaire Experience FILLABLE.pdf
PDF 358 KB Posted
- Attached to
- San Jacinto District Office Janitorial Services Federal contract opportunity
- Solicitation number
- 127EAT24Q0065
- Issued by
- Department of Agriculture Forest Service
About this file
This document is a Past Performance Questionnaire Experience form related to a federal contract opportunity for janitorial services at the San Jacinto Ranger District office. The form asks the contractor to provide information on their company background, including years of experience, use of subcontractors, and key personnel. It also requests details on the contractor's past performance on similar projects completed within the last 5 years, including contract numbers, amounts, locations, and client contact information. The final section requires the contractor to list any concurrent contractual commitments. The related federal contract opportunity is for custodial services at the San Jacinto Ranger District office, with a Solicitation Number of 127EAT24Q0065. The contract is being issued by the U.S. Department of Agriculture Forest Service.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment A0001 Solicitation 127EAT24Q0065.pdf | ||
| Attachment 2 Wage Determination 2015-5629 Rev 23 dated May_09_2024.pdf | ||
| 127EAT24Q0065 Janitorial Services.pdf | ||
| Attachment 1 Janitorial Services Statement of Work.pdf |
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Text version
Experience Questionnaire
1. Contractor Name, Address, Telephone Number, and Email Address:
No
2. COMPANY INFORMATION
UEI: __________________ Small Business: Yes
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. What types of equipment do you have experience working with that is relevant to this contract?
8. 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
9. Past Performance - List below the projects your business has completed within the last five (5) years that involved relevant projects of similar scope and size.
Contract Number Contract Amount Location of Work Names, Telephone No., and Email of Owner/Person to contact for Project Information
Description of Project
Contract Number Contract Amount Location of Work Names, Telephone No., and Email of Owner/Person to contact for Project Information
Description of Project
Contract Number Contract Amount Location of work Names, Telephone No., and Email of Owner/Person to contact for Project Information
Description of Project
10. 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.
11a. CERTIFYING OFFICIAL'S NAME AND TITLE
11b. SIGNATURE 12. 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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