A4 Past Performance QUESTIONNAIRE.pdf
PDF 186 KB Posted
- Attached to
- 12445123Q0032 German Ridge Waterline
- Solicitation number
- 12445123Q0032
- Issued by
-
Department of Agriculture Forest Service
About this file
This document contains a past performance questionnaire for contractors to provide references on previous similar projects. The questionnaire requests details on up to five relevant projects completed within the last three years, including contract amount, project type, completion date, and point of contact. Concurrently running projects must also be listed with contract number, dollar amount, awarded units, percentage completed, and customer information. Questions address years of experience, prime and subcontracting work history, and whether the offeror has ever failed to complete awarded work or had work completed by a performance bond. For each prior project, the contractor must provide a separate sheet describing their work scope and major subcontractors used, and address any technical areas uniquely relevant to the current solicitation.
The related federal contract opportunity is solicitation number 12445123Q0032 for the 12445123Q0032 German Ridge Waterline project with the Department of Agriculture Forest Service. The opportunity type is a solicitation but no other details are provided.
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Text version
Construction Services
Exhibit B: PERFORMANCE RELEVANCY QUESTIONNAIRE
Provide the following information requested in this format for each of the projects/contracts being described. Projects may be ongoing and cannot have been completed any later than 3 years prior to the to this issue date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify. Use as much space as required. OFFEROR SHOULD PLACE
THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE.
INSTRUCTIONS: If extra space is needed use the reverse. Mark "X" in appropriate boxes.
CONTRACTOR NAME, ADDRESS & TELEPHONE/Unique Sam ID
How many years do you or your firm have in the line of work contemplated by this solicitation ______? How many years experience in contracting have you or your business had as a (a) prime contractor _____ and/or (b) sub-contractor _____?
PART 1 - PAST / CURRENT PROJECTS
List below up to 5 projects your business has completed within the last 3 years similar in scope to the solicitation:
Contract Amount Type of Project Date Completed Name Address & Telephone No. of Person to Contact for Project Information.
List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:
Contract No. Dollar Amount of Project
Name, Address & Phone No. of Business Govt./Agency
Awarded (Units)
Completed
Date Contract Completed
Have you ever failed to complete any work awarded to you? Yes ( ) No ( ) Has work ever been completed by performance bond? Yes ( ) No ( ) If "Yes" to either item above specify location(s) and reason(s) why:
PART 2 – SPECIALIZED EXPERIENCE – For each of the projects listed above, address the following comments on a separate sheet:
a) Describe the specific elements of the work performed by your firm.
b) Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on Forest Service projects.
c) Address any technical areas about this project you consider uniquely relevant to this solicitation.
d) Point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number and facsimile number. Email address is also desired.
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 Forest Service with any information needed to verify my capability to perform this project.
Certifying Official's Printed Name and Title Signature Date
Solicitation:
Forest/State:
CharlesCotton Cross-Out
| CONTRACTOR NAME ADDRESS TELEPHONEUnique Sam ID: |
| How many years experience in: |
| andor b subcontractor: |
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| Awarded UnitsRow1: |
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| Name Address Phone No of Business GovtAgencyRow3: |
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| Name Address Phone No of Business GovtAgencyRow4: |
| Awarded UnitsRow4: |
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| If Yes to either item above specify locations and reasons why: |
| Group11: Choice1 |
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| Date18_af_date: |
| Text19: 12445123Q0032 German Ridge Water Line |
| Text20: Hoosier NF IN |
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