Attach 2 - Past Perf Questionnaire (23R1003).pdf
PDF 423 KB Posted
- Attached to
- WYANG Dredge Pond
- Solicitation number
- W50S8W23R1003
- Issued by
-
Department of the Army National Guard
About this file
This document is a past performance questionnaire for solicitation number W50S8W23R1003 to dredge a pond for the Wyoming Army National Guard. The questionnaire requests information on a past project including the name and location, the offeror's role as prime contractor or subcontractor, technical and contracting points of contact, contract type and scope of work, current status, dates for beginning and completing work, initial and final contract amounts, any problems encountered and resolutions, safety issues, and names of behavioral health professionals involved. Offerors are to attach any letters of appreciation that apply solely to the project.
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Text version
FFOR OFFICAL USE ONLY
RFP W50S8W-23-R-1003
ATTACHMENT 2 - PAST PERFORMANCE QUESTIONNAIRE
FOR OFFICAL USE ONLY
1.a. Project Name and Location: 1.b. Mark involvement for this project (Check the one that applies): (If other, describe in Block 26) Prime Contractor Sub-Contractor Joint Venture Other
2. Project owner’s complete address:
3a. Technical Point of Contact for project (Name, title, address, phone, fax, email):
4b. Contracting Point of Contact for the project (Name, title address, phone, fax, email):
4. Describe contract type (Service, etc), Nature and Scope of work:
4a. Current Status of Contract (Check the one that applies):
Work continuing, on schedule (must be greater than 50% complete) Work continuing, behind schedule Work completed, no further action pending Work completed, routine administrative action pending
Work completed, claims negotiation pending/underway Work completed, litigation pending/underway Terminated for convenience Terminated for default Other (explain in Block 26, Additional Comments)
5. Date work was begun (Day/Month/Year):
6. Date work was completed (Day/Month/Year):
Estimated Date of Completion: / / Actual Date of Completion*: / / *leave blank if project is ongoing
7. If actual completion date is later than initial completion date, explain why:
8. Initial contract price Amount for which Offeror was responsible:
$ _________________.00
9. Final invoiced amount (or amount invoiced to date) Amount for which Offeror was responsible:
$ _________________.00
10. If final invoiced amount greater than initial contract amount, explain why:
FFOR OFFICAL USE ONLY
RFP W50S8W-23-R-1003
ATTACHMENT 2 - PAST PERFORMANCE QUESTIONNAIRE
FOR OFFICAL USE ONLY
11. Project Name and Location:
12. Explain any problem(s) encountered, and solution to resolve problem(s):
13. Were there any safety problems or accidents? Explain:
Provide, based on the job description, the names of the following personnel that worked on this project in following positions:
Job Description: First Name, Last Name:
Status During Project
(Check the one that applies):
14. Behavioral Health Professional 14a. 14b. In-House Subcontractor
15b. In-House Subcontractor
16b. In-House Subcontractor
17. Additional Comments:
Please attach any Letters of Appreciation that apply ONLY to this project to this form.
File details come from the government source that posted it. Updated .