Attachment_4_Past_Performance_Questionnaire.pdf
PDF 125 KB Posted
- Attached to
- EDIS CONDUCT HAZARDOUS MATERIALS SURVEY Federal contract opportunity
- Solicitation number
- 140P4523Q0061
About this file
This document contains a past performance questionnaire and references form for solicitation 140P4523Q0061 to conduct hazardous materials surveys for the National Park Service Northeast Region. Offerors are required to provide details of three relevant past contracts over the last five years, including contract type and value, agency, points of contact, and duties performed. References should include names, phone numbers, and email addresses. The form requests company information and certifies that statements are complete and correct.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140P4523Q0061_Amd_0002.pdf | ||
| Questions_and_Answers_0002.pdf | ||
| Sol_140P4523Q0061_Amd_0001.pdf | ||
| Sol_140P4523Q0061.pdf | ||
| Attachment_6_Price_Schedule_HazMatSurvey.xls | XLS spreadsheet | |
| Attachment_1_SOW_HazMatSurvey.pdf | ||
| Attachment_3_Wage_Determination_HazMatSurvey.pdf | ||
| Attachment_2_Terms_and_Conditions.pdf | ||
| Attachment_5_Technical_Questionnaire.pdf |
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Text version
140P4523Q0061 EDIS Hazardous Materials Collections Condition Survey
POINT OF CONTACT: MARY HALLMON mary_hallmon@nps.gov
Past Performance Questionnaire
Contractor Name: Duns #
Address: City: State: Zip:
Phone Number: Fax Number:
Type of Business:
_____Company ____Co-partnership ______Corp._____ Individual ____Non-Profit Org.
How many years do you or your firm has in the types of work requested by this solicitation?
_________________year(s).
How many years experience in contracting have you or your business had as a Prime Contractor? _________year(s) and/or Sub-contractor: _______(years)
List below the three (3) projects your business has completed within the last five (5) years of the proposed service requested by this solicitation, include the contract amount, the type of project, date completed and your reference contact name, address, email address and telephone number: (SEE ATTACHED SHEET)
Have you ever failed to complete any work awarded to you? ______Yes _____No
Has work ever been completed by performance/payment bond? ______Yes ______No
If “Yes” to either item, specify location and reason:
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 National Park Service with any information needed to verify my capability to perform this project.
Certifying Official Name and Title:
Signature (Sign in Ink):
Date:
PAST EXPERIENCE & REFERENCES
REFERENCES:
This form must be completed by all quoters in order to receive consideration. If additional space is needed, this form may be duplicated as necessary. List any current or past experience which is pertinent to this position. Past performance and experience may be a combination of up to two contracts similar in size and complexity to those stated in the Technical Provisions and work experience in similar positions, performing duties similar in nature and complexity to the required services. Include (separately) details of any training which would enable you to better perform the work outlined in the specifications. Reference information should include a point-of-contact's name, telephone number and e-mail address. (IF
HANDWRITTEN, MUST BE LEGIBLE)
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: ____________________________________________
Brief description of duties
Experience No. 3
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: ____________________________________________
Brief description of duties:
Return form to:
Email: mary_hallmon@nps.gov mailto:mary_hallmon@nps.gov
Type of Business:
File details come from the government source that posted it. Updated .