Experience_Questionnaire_J5.doc
DOC document 60 KB Posted
- Attached to
- 2016 Road 150 Bridges Federal contract opportunity
- Solicitation number
- AG-8399-S-16-0020
About this file
Attachment J.5 Past Performance Questionnaire
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Text version
ATTACHMENT J.5
PAST PERFORMANCE QUESTIONNAIRE
1. CONTRACTOR NAME, ADDRESS, & TELEPHONE NUMBER
2. BUSINESS TYPE
[ ] COMPANY [ ] INDIVIDUAL
[ ] CORPORATION
[ ] CO-PARTNERSHIP
[ ] NON-PROFIT ORGANIZATION
3. HOW MANY YEARS DOES YOUR FIRM HAVE IN THE LINE OF WORK CONTEMPLATED BY THIS SOLICITATION?
4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS AN (a) PRIME CONTRACTOR __________ AND/OR (b) SUB-CONTRACTOR __________? IS THIS TIME CONCURRENT? ___________
5. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:
CONTRACT
AMOUNT
| TYPE OF PROJECT |
| DATE |
COMPLETED
NAME, ADDRESS & TELEPHONE NUMBER OF
OWNER/PERSON TO CONTACT FOR INFO.
6. CONTRACT
NUMBER
DOLLAR AMT.
OF AWARD
NAME, ADDRESS & PHONE NO.
OF AGENCY INVOLVED
| PERCENT COMPLETED |
| DATE |
COMPLETED
UNITS
AWARDED
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 ITEM 7a OR 7b, SPECIFY LOCATION(S) AND REASONS(S) WHY:
(continued)
8. ORGANIZATION AND WORK THAT WILL BE AVAILABLE FOR THIS PROJECT:
a.(1) MINIMUM NO. OF EMPLOYEES: __________ AND a.(2) MAXIMUM NO. OF EMPLOYEES: __________
b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL: [ ] YES [ ] NO
c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRACT:
d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 2.0 ACRES/MAN/DAY:
(1) MINIMUM PROGRESS RATE: __________ AND (2) MAXIMUM PROGRESS RATE: __________
9. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:
| INDIVIDUALS NAME |
| PRESENT |
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
10. REMARKS – SPECIFY BOX NUMBERS (also use this area to address any problems with past performance not noted in item 7):
(attach sheets if extra space is needed)
11. THE BIDDER SHALL INDICATE WHETHER OR NOT HE/SHE HAS EXAMINED THE AREAS FOR WHICH THIS BID
IS SUBMITTED: [ ] YES [ ] NO
IF YES, THE DATE AREA WAS EXAMINED: _________________________
| CERTIFICATION: I CERTIFY THAT ALL OF THE STATEMENTS MADE BY ME ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND |
| 12a. CERTIFYING OFFICIAL’S NAME & TITLE |
| THAT ANY PERSONS NAMED AS REFERENCES ARE AUTHORIZED TO FURNISH THE FOREST SERVICE WITH INFORMATION NEEDED TO VERIFY MY CAPABILITY TO |
| 12b. SIGNATURE (Sign in ink) |
PERFORM THIS PROJECT.
12c. DATE
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