CRQ.pdf

CONTRACTOR RESPONSIBILITY QUESTIONNAIRE PAGE 1 0F 2

FOLLOWING OFFER OPENING AND PRIOR TO AWARD, THE CONTRACTING OFFICER MUST

DETERMINE IF THE CONTRACTOR SELECTED FOR THE PROPOSED AWARD IS RESPONSIBLE

WITHIN THE MEANING OF FAR 9.103. THE PRIMARY FACTORS WHICH INFLUENCE THIS

DETERMINATION ARE THE FIRM'S ABILITY TO PERFORM THE REQUIRED WORK AND THE FIRM'S

FINANCIAL CAPABILITY. TO ASSIST THE CONTRACTING OFFICER IN THIS DETERMINATION,

PLEASE COMPLETE BOTH PAGES OF THIS FORM AND RETURN WITH YOUR OFFER. THE

GOVERNMENT WILL TREAT ALL INFORMATION SUBMITTED ON THIS FORM AS CONFIDENTIAL.

I. LIST THE FOLLOWING INFORMATION FOR THREE PROJECTS WHICH YOU HAVE

SUCCESSFULLY COMPLETED WITHIN THE PAST TWO YEARS, AND INVOLVES WORK SIMILAR TO

THAT REQUIRED BY THIS INVITATION FOR OFFER.

1. DESCRIPTION: _______________________________________________________________

OWNER: ______________________________________________________________

PERSON OF CONTACT: _______________________________________________________

TELEPHONE: ________________________________________________________________

AMOUNT: ________________________ DATE COMPLETED_______________________

2. DESCRIPTION: _______________________________________________________________

OWNER: ___________________________________________________________________

PERSON OF CONTACT: _______________________________________________________

3. DESCRIPTION: _______________________________________________________________

OWNER: ___________________________________________________________________

PERSON OF CONTACT: ______________________________________________________

II. THE CONTRACTOR MUST HAVE (1) ADEQUATE CAPITAL IN HAND TO PURCHASE MATERIALS,

MEET WEEKLY PAYROLLS, AND COVER OTHER JOB EXPENSES, OR (2) CREDIT AVAILABLE FROM

SUPPLIERS, BANKS, ETC. FOR THESE PURPOSES. PLEASE COMPLETE THE FOLLOWING:

A. I HAVE ADEQUATE FINANCIAL RESOURCES IN HAND TO PAY FOR:

( ) MATERIALS

( ) LABOR

( ) OTHER JOB EXPENSES

B. I HAVE CREDIT AVAILABLE FROM THE FOLLOWING FIRMS AND LENDING INSTITUTIONS: (LIST

NAME AND ADDRESS)

1.___________________________________________________________

2.___________________________________________________________

3.___________________________________________________________

I CERTIFY THAT THE INFORMATION ABOVE IS CORRECT.

SIGNATURE: _____________________________________

NAME OF COMPANY: _____________________________________

BY: _______________________________________

TITLE: _____________________________________________