C05_Attch 8 -Past Performance Questionnaire.pdf
PDF 56 KB Posted
- Attached to
- Smith River Vault Toilet Pumping
- Solicitation number
- 127EAY26Q0079
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Past Performance Questionnaire template required by the USDA Forest Service for federal contract solicitations (Reference FSH 6309.31 and 41 USC 1).
The questionnaire is designed to evaluate a contractor's qualifications and performance history prior to contract award. Contractors must provide their business name, address, and telephone number, specify their business structure (Company, Corporation, Co-partnership, Individual, or Non-profit Organization), and document their years of experience in both the specific line of work and general contracting experience as either prime or subcontractor. The form requires detailed listing of projects completed within the previous three years, including contract amount, project type, completion date, and owner/contact information for reference verification. Contractors must also disclose whether they have ever failed to complete awarded work, with explanation if applicable. A remarks section allows contractors to provide additional information or clarifications referenced by box number. The questionnaire concludes with a certification statement signed by an authorized official, attesting that all provided information is complete and correct and authorizing the Forest Service to contact named references to verify the contractor's capability to perform the project. This form serves as a standard evaluation tool for assessing contractor past performance and reliability for USDA Forest Service contract opportunities.
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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
127EAY26Q0064
Attch 5
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