Attachment 4 - Contractor Responsibility Questionnaire.docx

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Attached to
FSH Window Replacement
Solicitation number
FA301622Q0041
Issued by

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FA301622Q0041

Attachment 4

Contractor Responsibility Questionnaire

Contractor Name: Address:

Point of Contact:

In the solicitation past performance will not be one of the evaluation factors, however, IAW FAR Part 9.1, the Contracting Officer shall determine whether prospective contractors are responsible. Therefore, please provide the following information:

UPROJECT # 1

1. Contract Number:

2. Project Title: _

3. Award Date:

4. Scope of Work:

5. Contract Value:

6. Contracting Officer/Customer Contact Information:

UPROJECT # 2

1. Contract Number:

2. Project Title: _

3. Award Date:

4. Scope of Work:

5. Contract Value:

6. Contracting Officer/Customer Contact Information:

UPROJECT # 3

1. Contract Number:

2. Project Title: _

3. Award Date:

4. Scope of Work:

5. Contract Value:

6. Contracting Officer/Customer Contact Information:

Signature and Date

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