Attachment_4-_Past_Performance_Data_Document.docx
DOCX document 45 KB Posted
- Attached to
- Amphibious Tracked Vehicle, Blackwater NWR
- Solicitation number
- 140FS326R0005
About this file
This is a Past Experience & References Questionnaire template required for proposal submission to the U.S. Fish and Wildlife Service for Solicitation 140FS326R0005, an RFQ for an Amphibious Tracked Vehicle for Blackwater National Wildlife Refuge. The form mandates that all information be completed for compliance with the solicitation requirements.
The questionnaire requires prospective contractors to provide company identification information (name, SAM UEI, address, and point of contact details), years of experience in services and federal contracting, and disclosure of any past contract failures. Contractors must document key personnel availability, including minimum and maximum employee counts, payroll status, and anticipated staffing levels for the project. The form requires detailed information on employee experience for all personnel who will perform the contracted work, including position titles and years of experience. Additionally, contractors must provide three contract references completed within the past three years that are similar in size and complexity to the Scope of Work, with preference given to government contracts. Each reference must include the contracting agency or company name, contract number, total contract value, point of contact information, contract dates, and detailed scope description. The form concludes with a certification statement requiring the submitting official to attest that all provided information is complete and accurate, and that referenced parties are authorized to provide verification information to the government regarding the contractor's capability to perform the project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326R0005_Amd_0002.pdf | ||
| Attachment_3-Quote_Schedule_corrected_0001.docx | DOCX document | |
| Sol_140FS326R0005_Amd_0001.pdf | ||
| Attachment_1-_Solicitation_Provisions_and_Clauses.pdf | ||
| Sol_140FS326R0005.pdf | ||
| Attachment_2-_Supply_Requirement.pdf | ||
| Attachment_3-Quote_Schedule.docx | DOCX document |
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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 .