ATTACHMENT 3 - Present Past Performance Questionnaire.docx

ATTACHMENT 3

SECURITY GUARD SERVICES—FOREST PRODUCTS LABORATORY (FPL-05-002)

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

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:_____________________________________