Att D Past Performance Form.docx
DOCX document 31 KB Posted
- Attached to
- ANF SO & DO Janitorial Services Federal contract opportunity
- Solicitation number
- 127EAT21R0018
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 127EAT21R0018_Amd_0002 RFIs and Answers.pdf | ||
| 127EAT21R0018_Amd_0001.pdf | ||
| 127EAT21R0018.pdf | ||
| Att E Wage Determination.pdf | ||
| Att A 1st Floor Plan.pdf | ||
| Att B 2nd Floor Plan.pdf | ||
| Att C ATCC Floor Plan.pdf |
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Text version
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
| 2. SUBMITTED TO (office Name and Address) |
| 3. BUSINESS |
| Company | Co-partnership |
| Corporation | Individual |
Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years experience have you or your business had as a (a) prime contractor and/or (b) sub-contractor ?
6. List below the projects your business has completed within the last three years:
FACTOR #1: PAST PERFORMANCE INFORMATION
CONTRACT AMOUNT
TYPE OF PROJECT
| DATE COMPLETED |
| NAME, ADDRESS, AND TELEPHONE NO. OF |
OWNER/PERSON TO CONTACT FOR PROJECT INFORMATION
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| CONTRACT NUMBER |
| DOLLAR AMT. OF AWARD |
| NAME, ADDRESS, AND TELEPHONE NO. OF BUSINESS/GOVERNMENT AGENCY INVOLVED |
| AWARDED |
(Units)
| PERCENT COMPLETED |
| DATE |
CONTRACT COMPLETED
| 8a. Have you ever failed to complete any work awarded to you? | Yes No | |
| 8b. Has work ever been completed by performance bond? | Yes No 8c. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why: |
Previous edition is obsolete (OVER)
FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
| a. (1) Minimum number of employees: | and a(2) Maximum number of employees: | ? |
| b. Are employees regularly on your payroll: Yes | No |
c. Specify equipment available for this contract:
10. List below the experience of the principal individuals of your business:
| INDIVIDUAL’S NAME |
| PRESENT POSITION |
| YEARS OF EXP. |
| MAGNITUDE AND TYPE OF WORK |
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 name as references are authorized to furnis the Forest Service with any information needed to verify my capability to perform this project.
12a. CERTIFYING OFFICIAL’S NAME AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
(Use Additional Sheets As Needed) image1.png image2.png
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