Attachment C Past Performance Questionnaire.pdf
PDF 94 KB Posted
- Solicitation number
- 127EAT25Q0006
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire form from the USDA Forest Service, designed to collect information about a contractor's experience and capability to perform work. The form requires contractors to provide details about their business structure (company, corporation, co-partnership, individual, or non-profit organization), years of experience in the relevant work, and experience as both prime and subcontractors.
The questionnaire includes a table for listing projects completed within the last three years, requiring contract amounts, project types, completion dates, and reference contact information. It also asks whether the contractor has ever failed to complete awarded work and requires an explanation if applicable. The form concludes with a certification section where an official must attest to the accuracy of the information provided. This questionnaire is being used specifically for a tree trimming service contract at Los Prietos Ranger Station in Los Padres National Forest, solicitation number 127EAT25Q0006.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A Statement of Work - Los Prietos Tree Removal Oct 2024.pdf | ||
| Attachment B Wage Determination.pdf | ||
| 127EAT25Q0006.pdf |
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Text version
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 the projects your business has completed 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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