Attachment_4-_Past_Performance_Data_Document.docx
DOCX document 47 KB Posted
- Attached to
- Firebreak Installation, Piedmont NWR, GA Federal contract opportunity
- Solicitation number
- 140FS326Q0082
About this file
This is a Past Experience & References Questionnaire template designed to evaluate contractor qualifications and past performance for federal contract consideration. Contractors must complete all sections to achieve compliance with the solicitation requirements for Firebreak Installation at Piedmont National Wildlife Refuge in Georgia (Solicitation 140FS326Q0082).
The questionnaire requires contractors to provide comprehensive information including company registration details (SAM UEI), years of experience in services and federal contracting (as prime or subcontractor), and disclosure of any failed contract completions. Contractors must identify key personnel available for the project, including minimum and maximum employee counts, payroll status, and anticipated staffing levels for the specific work. Employee experience details must be provided for each personnel member assigned to perform work. The document mandates submission of a minimum of 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 requires detailed information including the contracting agency or company name, contract value, contract number, point of contact details, performance dates, and a detailed scope description sufficient for government evaluation. Contractors must certify that all statements are complete and accurate, and that references are authorized to provide verification of business and employee capability to perform the project.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment_1-_Performance_Work_Statement.pdf | ||
| Sol_140FS326Q0082.pdf | ||
| Attachment_2-_Quote_schedule.docx | DOCX document | |
| Attachment_3-_SCA_Wage_Determination.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 .