4__PPQ_Lewistown_Fire_UPS_Room_Mini_Split_AC_Replacement.docx
DOCX document 25 KB Posted
- Attached to
- Lewistown Fire UPS Room AC replacement
- Solicitation number
- 140L3626Q0039
About this file
This is a Past Performance Questionnaire that contractors must complete and submit with their quotes for the Lewistown Fire UPS Room AC Replacement solicitation (140L3626Q0039) issued by the Department of the Interior Bureau of Land Management. The questionnaire is a template designed to evaluate contractor qualifications and capability to perform the work.
The form requires contractors to provide company information including name, address, phone number, and SAM Entity Number (UEI), along with business type classification. Contractors must document relevant experience in years for both the individual and company, as well as specify years of experience as a prime contractor and subcontractor. The questionnaire mandates submission of completed projects from the past three years with contract numbers, project amounts, completion dates, and reference contacts; notably, only projects relevant to the solicitation's technical and complexity requirements will be considered. Additional required disclosures include concurrent contract commitments with start and finish dates, any history of incomplete work, and whether performance bonds were required. The form concludes with a certification section requiring the authorized official's signature, printed name, title, and date, certifying the accuracy and completeness of all statements provided.
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Text version
Past Performance Questionnaire
(THIS MUST BE COMPLETED AND SUBMITTED WITH YOUR QUOTE)
Contractor Name:______________________________________________________________________
Address:__________________________________ City:_______________ State: _____ Zip:________
Phone Number: ____________________ SAM Entity Number (UEI): ____________________________
Type of Business:
_____Company ____Co-partnership ______Corp._____ Individual ____Non-Profit Org.
1. How many years of RELEVENT experience do you have and/or your company have regarding the types of work requested by this solicitation?
-You__________________ -Your Company__________________
2. How many years of experience in contracting does your company have as a Prime Contractor and/or a Sub-Contractor:
-Prime_________________ -Sub-Contractor__________________
3. List below projects your business has completed within the last three years. Include the contract number and amount; the type of project; the date completed and a reference contact name and telephone number for each project.
Note: Past Projects must be relevant to the requirements of this solicitation in terms of duties performed, and the technical/complexity aspects of the duties required. Projects listed that are not relevant to this solicitation and its requirements will not be considered. (attach separate page if additional room is needed)
4. List all contract commitments you have that will run concurrently with the work requested in this solicitation. Include name, address, telephone number, start and finish date.
5. Have you ever failed to complete any work awarded to you? ______Yes _____No
6. Has work ever been completed by performance bond? ______Yes ______No
If “Yes” to either item, specify location and reason:
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons named as references are authorized to furnish the Bureau of Land Management with any information needed to verify my capability to perform this project.
Certifying Official Name and Title :
Authorized Signature (Sign in Ink):
Date:
File details come from the government source that posted it. Updated .