127EAY26Q0012 Attachment 4 -Past Performance Questionnaire.pdf
PDF 85 KB Posted
- Attached to
- Smith River Janitorial
- Solicitation number
- 127EAY26Q0012
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a USDA Forest Service Past Performance Questionnaire used to evaluate contractor capability and experience for federal solicitations. The form requests comprehensive information about the contractor's business background, project history, and contracting experience.
The questionnaire requires contractors to provide their company name, address, and contact information; identify their business type (company, corporation, co-partnership, individual, or non-profit organization); and document their years of experience in the relevant line of work and contracting history as both prime and subcontractors. Contractors must list all projects completed within the three-year period preceding submission, including contract amounts, project types, completion dates, and owner/contact information for reference verification. The form specifically asks whether the contractor has ever failed to complete awarded work and requires explanation if affirmative. A certification section requires the certifying official's signature and attestation that all statements are complete and correct, and that named references are authorized to provide information to the Forest Service regarding the contractor's capability to perform the project. Additional remarks and explanations may be provided in Box 11 if extra space is needed. The form references FSH 6309.31 and 41 USC 1 as applicable regulations.
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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
127EAY26Q0012
Attch 4
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