Attachment 4 Past Performance Questionnaire.pdf
PDF 102 KB Posted
- Solicitation number
- 127EAT26Q0016
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a USDA Forest Service Past Performance Questionnaire for a Wildland Fire Training Center Janitorial contract (Solicitation Number 127EAT26Q0014) located in McClellan, California. The form is designed to collect contractor information including business type, years of experience, previous project history, and performance verification. The questionnaire requires the potential contractor to provide details about their contracting experience as a prime or subcontractor, list completed projects from the past three years, and certify the accuracy of the submitted information. Key sections include self-reporting on years of relevant work experience, a table for documenting previous project details, and a certification statement affirming the completeness and correctness of the provided information.
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Text version
USDA – Forest Service
PAST PERFORMANCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
2. SUBMITTED TO (office Name and Address)
3. BUSINESS
Company Co-partnership Corporation Individual Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years of experience in contracting have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
CONTRACT
AMOUNT TYPE OF PROJECT
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7a. Have you ever failed to complete any work awarded to you? Yes No 7b. If “Yes” to Item 8a type of project and reason(s) why:
8. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
9a. CERTIFYING OFFICIAL’S NAME AND TITLE
b. SIGNATURE (Sign in ink) 10. DATE
127EAT26Q0014 - Wildland Fire Training Center Janitorial McClellan, California
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