Attachment_4-Past_Performance_Questionnaire.pdf
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- RX Fire Break Clearing Mulching
- Solicitation number
- 140F0222R0034
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A. Past Performance Questionnaire (Offeror Document)
This form must be completed by all quoters/bidders in order to receive consideration. If additional space is needed, this form may be duplicated as necessary. List any current or past experience that is pertinent to this position. Past performance and experience may be a combination of up to three contracts similar in size and complexity to those stated in the Performance Work Statement (PWS) and work experience in similar positions, performing duties similar in nature and complexity to the required services. Reference information should include a point-of-contact's name, telephone number and e-mail address.
Experience No. 1
Contract/Work type: ____________________________________________
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed:
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended:
Brief description of duties:
Experience No. 2
Contract/Work type: ____________________________________________
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed:
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended:
Experience No. 3
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed:
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended:
Experience 4
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed:
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended:
Submit NLT than the due date and time specified within this solicitation to: E-mail: joann_mallory@fws.gov mailto:joann_mallory@fws.gov
A. Past Performance Questionnaire
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