Attachment 3 Relative Experience-Past Performance Questionnaire.pdf
PDF 179 KB Posted
- Solicitation number
- 12444126Q0017
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Relative Experience/Past Performance Questionnaire for federal contract solicitation 12444126Q0017, concerning short-term office rental for the Long Cane Ranger District. The questionnaire is a template designed to collect detailed information from prospective contractors regarding their qualifications and relevant experience.
The form requires contractors to provide basic company information, including business type (company, corporation, co-partner, non-profit, or individual), years of experience in the field, and years of experience as a prime contractor versus subcontractor. Contractors must list relevant projects completed within the last three years with sufficient detail, including contract numbers, award amounts, client names and addresses, contact information, and comprehensive descriptions of work performed. The questionnaire also requires disclosure of any failures to complete awarded work or instances where performance bonds were used, along with explanations for such occurrences. Additionally, contractors must identify principal individuals and their experience, provide credit references and banking points of contact for responsibility determination, and submit a certification attesting to the accuracy and completeness of all statements. The form permits attachment of additional sheets titled "Relevant Experience Questionnaire" if extra space is needed to fully address any item.
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Text version
12444126Q0017 Short-term Office Rental for the Long Cane Ranger District Attachment 3
Relative Experience/Past Performance Questionnaire
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached, using the title “Relevant Experience Questionnaire”
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual
3. How many years experience do you have in this line of work ____Yrs
4. How many years experience as a prime contractor _____ subcontractor ___
5. LIST OF RELEVANT PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST
THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included (i.e., what tasks were performed, (Project Management Space Planning to include disassemble/relocate/reassemble cubicles, connections for electrical and connectivity per quad, relocation of personal & office items, running of CAT and electrical wiring and ordering miscellaneous hardware and supplies as needed. ) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6b. Has work ever been completed by performance bond? __yes __ no
6. If "yes" to either item 6a or 6b specify location(s) and reason(s) why
7. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References
Company Name/Address Point of Contact Telephone number Materials/Services Provided
b. Banking Information. (NOTE: Only POC information is required. Please do NOT provide your account information.)
Company Name/Address Point of Contact Telephone number
9. REMARKS (Additional sheets may be attached, using the title “Relevant Experience Questionnaire”)
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 named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project:
Name:
Title: Date:
File details come from the government source that posted it. Updated .