Attachment 3 Past Performance Questionnaire.pdf
PDF 94 KB Posted
- Attached to
- Self-contained breathing apparatus (SCBA) gear
- Solicitation number
- 127EAT23Q0054
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a past performance questionnaire template for contractors to provide references on previous relevant contracts for the USDA Forest Service. It requests information on the contractor including years of experience, completed projects in the last three years with owner references, and whether they have failed to complete any work. The related federal contract opportunity is a solicitation from the Department of Agriculture Forest Service for self-contained breathing apparatus gear. It lists the solicitation number and provides the agency and opportunity type.
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Other files
| File | Type | Posted |
|---|---|---|
| 127EAT23Q0054 RFQ.pdf | ||
| Attachment 2 FPS 7000 SCBA Full Face Mask.pdf | ||
| Attachment 1 PSS 5000 NFPA-Certified SCBA.pdf |
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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
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