Past Performance Questionnaire.pdf
PDF 94 KB Posted
- Solicitation number
- 127EAT26Q0021
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire form used by the USDA Forest Service to evaluate contractor capability and experience prior to contract award. The form references FSH 6309.31 and 41 USC 1 as governing standards.
The questionnaire requires contractors to provide their business information, including company name, address, and telephone number, as well as business type (company, corporation, co-partnership, individual, or non-profit organization). Contractors must disclose years of experience in their specific line of work and years of contracting experience as both prime contractors and subcontractors. The form requires a detailed listing of projects completed within the last three years, including contract amount, project type, completion date, and owner/contact person information for reference verification. Contractors must certify whether they have ever failed to complete awarded work and, if so, provide explanations. The form includes a remarks section for additional information and requires certification by an authorized official with signature and date. The certification statement indicates that referenced parties are authorized to provide the Forest Service with information needed to verify the contractor's capability to perform the project.
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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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