127EAYQ260014 Attachment 4 - Past Performance Questionnaire.pdf
PDF 49 KB Posted
- Attached to
- WH&Bs Transport to Tennessee
- Solicitation number
- 127EAY26Q0014
- 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 their company name, address, and telephone number, specify their business structure (company, corporation, co-partnership, individual, or non-profit organization), and disclose years of experience in the relevant line of work and contracting experience as both prime and subcontractors. Contractors must list projects completed within the last three years, including contract amounts, project types, completion dates, and contact information for project owners or references. The form specifically asks whether the contractor has ever failed to complete awarded work, requiring explanation if the answer is affirmative. A remarks section is provided for additional information and clarifications. The form concludes with a certification statement in which the certifying official confirms the accuracy of all statements and authorizes the Forest Service to contact named references to verify the contractor's capability to perform the project. The certification must be signed in ink with the official's name, title, and date of submission.
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Other files
| File | Type | Posted |
|---|---|---|
| 127EAYQ260014 Attachment 3 - Schedule of Items.docx | DOCX document | |
| 127EAY26Q0014 Attachment 1 - Solicitation Terms and Conditions.docx | DOCX document | |
| 127EAYQ260014 Attachment 5 - Wage Determination 2015-5677 Revision 29 dtd 12-03-2025.pdf | ||
| 127EAY26Q0014 Attachment 2 - Statement of Work.docx | DOCX document |
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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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