C05_Attch 4 -Past Performance Questionnaire Rev 1.pdf
PDF 151 KB Posted
- Solicitation number
- 127EAY26Q0095
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Past Performance Questionnaire used to evaluate contractor capability and experience for solicitation 127EAY26Q009.
The questionnaire requires contractors to provide comprehensive past performance information including: contractor name, address, and telephone number; business type (company, corporation, co-partnership, individual, or non-profit organization); years of experience in the line of work contemplated by the solicitation; years of contracting experience as both prime contractor and subcontractor; and a detailed list of projects completed within the last five years with contract amounts, project types, completion dates, and owner/contact information. Contractors must also disclose whether they have ever failed to complete awarded work and explain any such failures. The form includes a certification section in which the certifying official attests under penalty of perjury that all statements are complete and correct and that named references are authorized to provide verification of the contractor's capability to perform the project. The questionnaire references FSH 6309.31 and 41 USC 1 and permits use of attachment sheets for responses requiring additional space beyond the form's provided fields.
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Text version
127EAY26Q009
5 Attch 4 Rev 1
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 five 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?
7b. If “Yes” to Item 8a type of project and reason(s) why:
Yes No
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
File details come from the government source that posted it. Updated .