127EAY26Q0008 Attachment 4 - Past Performance Questionnaire.pdf
PDF 49 KB Posted
- Attached to
- Fire Engine Repair/Replacement
- Solicitation number
- 127EAY26Q0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Past Performance Questionnaire form used to evaluate contractor capability and experience for federal contract opportunities.
The form requires contractors to provide comprehensive background information including company name, address, and telephone contact details, along with business structure classification (company, corporation, co-partnership, individual, or non-profit organization). Contractors must document years of experience in their specific line of work and years of contracting experience as both prime contractors and subcontractors. Section 6 requires listing of all projects completed within the past three years, including contract amounts, project types, completion dates, and owner/contact information for reference verification. The form includes a critical past performance question asking whether the contractor has ever failed to complete awarded work, with space to explain any failures. A remarks section (Box 8) allows contractors to provide additional information or explanations as needed. The form concludes with a certification statement in which the certifying official affirms the accuracy and completeness of all submitted information and authorizes the Forest Service to verify capability to perform the project. The official must sign the form in ink and provide their name, title, and the submission date. The questionnaire references FSH 6309.31 and 41 USC 1 as regulatory authorities.
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Text version
USDA – Forest Service
PAST PERFORMANCE QUESTIONNAIRE
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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