Past Performance Form.docx

DOCX document 16 KB Posted

Attached to
Recovery - Trail Bridges Federal contract opportunity
Solicitation number
AG-4419-S-10-0417
Issued by
Department of Agriculture Forest Service Washington Office Economic Recovery Operations Center East

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Past Performance Form

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Other files attached to Recovery - Trail Bridges, newest first.
File Type Posted
Amendment No. 1.pdf PDF
Drawings.pdf PDF
AG-4419-S-10-0417.pdf PDF
Specification.pdf PDF
SF-1442.doc DOC document

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EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE

Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items.

1. Contractor's Name, Address & Telephone Number
2. Type of Business

____ Company

____ Corporation

____ Non-profit Organization

____ Co-partner

____ Individual

3. How many years of experience do you have in this line of work? ___________________

4. How many years of experience as a prime contractor? _________ subcontractor? ________

5. List similar projects your business has completed in the last 5 years.

Contract Amount

Type of Project
Date

Completed Name and Telephone Number to Contact For Information

6. List all of your firm's current contract commitments.

Contract Number Contract Amount

Type of Project
Est. Date of

Completion Name and Telephone Number to Contact For Information

7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no 7b. Has work ever been completed by performance bond? ____ yes ____ no 7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):

8. Organization that will be available for this project:

a.Minimum No. of employees: _______________ Maximum No. of employees: ________________
b.Are employees regularly on your payroll? ____ yes ____ no
c.If applicable, specify equipment available for this contract:

9. List the experience of the principal individuals of your business.

Individual's Name
Present Position
Years Experience
Type of Work

10. If subcontractors will used, identify the type and approximate percentage of work they will be performing on this project: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. Remarks:

CERTIFICATION: I certify that all of the statements made above are complete and correct to the best of my knowledge and that ny persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.

Signature Title Date

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