ATTACHMENT 6 PAST PERFORM QUEST.docx

AG-4568-S-12-0022 NCNF Road Maintenance IDIQ

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

Offerors are to complete Section A, then Forward it to their references to complete and fax to the attention of Karen Welch, at 828-257-4876 NLT March 13

Attachment 6 must be received directly from the reference, not the offeror.

SECTION A: CONTRACTOR INFORMATION

A. Contractor’s Name and Address: ________________________________________________

B. Point of Contact: ______________________________________________________________

C. Phone #: ____________________________________________________________________

D. Contract Number: ___________________ Contract Type: ____________________

E. Project Title: _________________________________________________________________

F. Period of Performance: _________________________________________________________

G. Brief Description/Scope of Services provided: _________________________________________

H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire.

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

RESPONDENT INFORMATION:

A. Name:______________________________________ B. Position:________________ C. Telephone Number:_____________________ Fax Number: ______________ D. Address:___________________________ E. Relationship and Time Involved with Contractor:___________________ F. Date Questionnaire Completed:_______________________

ATTACHMENT 6

CONTRACT PERFORMANCE

No

N/A

No

N/A

No

N/A

No

N/A

No

N/A

QUALITY OF SERVICE/CONTROL

No

N/A

TIMELINESS OF PERFORMANCE

No

N/A

No

N/A

REMARKS: If additional remarks are necessary, please attach an additional sheet.

ATTACHMENT 6