Attachment_4-_Past_Performance_Data_Document.docx
DOCX document 47 KB Posted
- Attached to
- Fire System Inspections and Services, Kodiak NWR Federal contract opportunity
- Solicitation number
- 140FS326Q0059
About this file
This is a Past Experience & References Questionnaire template that contractors must complete and submit with their proposal to demonstrate compliance with solicitation requirements for the Fire System Inspections and Services contract at Kodiak National Wildlife Refuge.
The questionnaire requires contractors to provide comprehensive information about their business qualifications and past performance. Contractors must document their years of experience in services and federal contracting (as prime or subcontractors), disclose any work failures, and detail key personnel availability including minimum and maximum employee counts and anticipated staffing for the project. The form requires information on individual employee experience for all personnel performing work under the solicitation. Contractors must provide at least three contract references from work completed within the past three years that are similar in size and complexity to the scope of work, with government contracts preferred. Each reference entry requires the contracting agency or company name, contract number, total contract value, point of contact information with phone and email, contract dates, and a detailed scope of project description sufficient for government evaluation. The certifying official must sign and date the form, certifying that all statements are complete and correct and that named references are authorized to provide verification information to the government. The questionnaire is designed to evaluate contractor capability to perform fire system inspection and service work for the U.S. Fish and Wildlife Service.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment_3-_SCA_Wage_Determination.pdf | ||
| Attachment_2-Quote_Schedule.docx | DOCX document | |
| Attachment_1-_Performance_Work_Statement.pdf | ||
| Sol_140FS326Q0059.pdf |
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Text version
PAST EXPERIENCE & REFERENCES QUESTIONNAIRE
**ALL INFORMATION MUST BE PROVIDED TO BE COMPLIANT WITH SOLICITATION**
Your Company Name:
SAM Unique Entity ID (UEI)#:
Street Address:
City, State and ZIP Code:
POC Name:
POC Phone Number:
POC Email:
Type of Business: Corporation Partnership Sole Proprietor Other (describe)
To receive consideration, complete and submit the information requested below with your proposal. If additional space is needed this form may be duplicated as necessary or you can provide your own form.
1) How many years’ experience does your business have in services? .
2) How many years’ experience in contracting has your business had as a Prime Contractor , or a Sub- contractor . How many of these years were performed for Federal Government Contracts .
3) Have you ever Failed to Complete any work awarded to you? Yes or No. If “yes” specify reasons why.
Past Experience Questionnaire – 140F0922Q0105 Page 1 of 2
4) Key Personnel Available for this Project:
a) Minimum # of Employees:
Maximum # of Employees:
b) Are employees regularly on your payroll? Yes or No
c) How many employee(s) do you anticipate to perform the work contemplated by this solicitation?
d) Are you a sole proprietor? Yes or No
e) If you are a Prime Contractor hiring a Sub Contractor, provide the name and location of the Sub Contractor: .
5) Employee Experience: Provide the below information for each employee(s) who will perform the work contemplated by this solicitation:
Present Position/Title: Years of Experience:
6) References and Relevant Past Performance/Experience:
Experience must have been completed within the past three (3) years and be similar in size and complexity to those stated in the Scope of Work. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
First Contract Reference:
Contract Agency or Company Name:
Contract Number (if applicable):
Total Contract $ Value:
Point of Contact (POC) Name:
POC Telephone #:
POC E-mail address:
Contract Start and End Date:
Scope of Project: (Sufficient detailed information must be provided for the Government to perform an evaluation)
Second Contract Reference:
Contract Agency or Company Name:
Contract Number (if applicable):
Total Contract $ Value:
Point of Contact (POC) Name:
POC Telephone #:
POC E-mail address:
Contract Start and End Date:
Scope of Project: (Sufficient detailed information must be provided for the Government to perform an evaluation)
Third Contract Reference:
Contract Agency or Company Name:
Contract Number (if applicable):
Total Contract $ Value:
Point of Contact (POC) Name:
POC Telephone #:
POC E-mail address:
Contract Start and End Date:
Scope of Project: (Sufficient detailed information must be provided for the Government to perform an evaluation)
7) 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 Government with any information needed to verify my business and employee’s capability to perform this project.
Certifying Official’s Name and Title: Date:
File details come from the government source that posted it. Updated .