Attachment 6 - Past Performance Questionaire.pdf

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Attached to
Angell JCCCC Elevator Maintenance and Inspection
Solicitation number
1282A726Q0030
Issued by

About this file

This is a Past Performance Questionnaire required by the USDA Forest Service for contractors responding to solicitations.

The questionnaire collects information about a contractor's relevant experience and performance history. Contractors must provide their company name, address, and telephone number, identify the office to which they are submitting, and specify their business structure (company, corporation, co-partnership, individual, or non-profit organization). The form requests the number of years the contractor has worked in the line of work contemplated by the solicitation, as well as years of experience as a prime contractor and subcontractor. Section 6 requires contractors to list relevant projects completed within the last three years, including contract amount, project type, completion date, and the name, address, and telephone number of the owner or contact person for project information. The questionnaire also asks whether the contractor has ever failed to complete any awarded work, with space to explain reasons if applicable. A remarks section allows contractors to provide additional information or clarifications. The form concludes with a certification statement in which the certifying official attests to the accuracy and completeness of all statements provided and authorizes the Forest Service to verify the contractor's capability to perform the project. The official must sign the form in ink and provide the date of certification.

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USDA – Forest Service

PAST PERFORMANCE QUESTIONNAIRE

(Ref. FSH 6309.31 and 41 USC 1)

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 relevant 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

Attachment 6 - Past Performance Questionaire

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