Attachment 3 Past Performance Questionnaire 127EAT26Q0002.pdf
PDF 733 KB Posted
- Attached to
- San Bernardino Janitorial Service
- Solicitation number
- 127EAT26Q0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Past Performance Questionnaire for a USDA Forest Service janitorial services contract (Solicitation 127EAT26Q0002) for the San Bernardino National Forest. The form is designed to collect information about a potential contractor's business experience, past projects, and performance history. Key sections require the contractor to provide details about their business type, years of experience in the relevant work, prime and subcontractor experience, completed projects in the last three years, and certification of the information's accuracy. The form must be submitted to Fareedah Vaughn, Contract Specialist, with contact information provided at the bottom of the document.
The questionnaire seeks comprehensive information to evaluate the contractor's capability to perform janitorial services, including a section to disclose any previous failures to complete contracted work. The form allows for additional explanatory remarks and requires the certifying official to sign and date the document, affirming the completeness and correctness of the provided information. While the specific details of the janitorial services are not elaborated in this document, it serves as a critical assessment tool for the USDA Forest Service to assess a contractor's qualifications for the San Bernardino National Forest janitorial services contract.
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Text version
USDA – Forest Service
PAST PERFORMANCE 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 of experience in contracting 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:
CONTRACT
AMOUNT TYPE OF PROJECT
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7a. Have you ever failed to complete any work awarded to you? Yes No 7b. If “Yes” to Item 8a type of project and reason(s) why:
8. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
9a. CERTIFYING OFFICIAL’S NAME AND TITLE
b. SIGNATURE (Sign in ink) 10. DATE
USDA Forest Service Attn: Fareedah Vaughn, Contract Specialist Email: fareedah.vaughn@usda.gov
127EAT26Q0002 - San Bernardino NF Janitorial Services
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