6. Past Performance Questionnaire.pdf
PDF 99 KB Posted
- Solicitation number
- 127EAT26Q0010
- 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 solicited work. The form is referenced in Forest Service Handbook 6309.31 and 41 USC 1 and must be submitted to the Forest Service office of Erin Scott-James, Contract Specialist, via email at erin.scott-james@usda.gov.
The questionnaire requires contractors to provide company information including business type (Company, Corporation, Co-partnership, Individual, or Non-profit Organization) and years of experience in the relevant line of work. Contractors must disclose their experience as both prime contractors and subcontractors and list all projects completed within the last three years, including contract amounts, project types, completion dates, and contact information for project owners or references. The form also requires disclosure of any failures to complete awarded work, with explanation of reasons if applicable. The certifying official must sign and date the form in ink, certifying under penalty of perjury that all statements are complete and correct and that named references are authorized to provide verification information to the Forest Service regarding the contractor's capability to perform the project.
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Text version
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.
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
2. SUBMITTED TO (office Name and Address) USDA Forest Service Attn: Erin Scott-James, Contract Specialist Email: erin.scott-james@usda.gov
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