127EAY26Q0024 Attachment 4 - Past Performance Questionnaire.pdf
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- Solicitation number
- 127EAY26Q0024
- 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 for federal contract opportunities. The form is referenced in Forest Service Handbook (FSH) 6309.31 and 41 USC 1 and is submitted to the Modoc National Forest office in Alturas, California (Solicitation Number 127EAY26Q0024).
The questionnaire requires contractors to provide: contractor name, address, and telephone number; business entity type (company, corporation, co-partnership, individual, or non-profit organization); years of experience in the relevant line of work; years of experience as both prime and subcontractors; a detailed list of projects completed within the past three years, including contract amounts, project types, completion dates, and owner/contact information; and disclosure of any instances where the contractor failed to complete awarded work, with explanations if applicable. The form includes a remarks section for additional information and requires certification by an authorized official with signature and date, in which the certifying official attests that all statements are complete and correct and that references are authorized to provide verification of the contractor's capability to perform the project.
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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
USDA-FS CSA SOUTHWEST 1
Modoc NF, 225 West 8th Street Alturas, CA 96101
127EAY26Q0024
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