Attachment 4--Past Performance Questionnaire FILLABLE.pdf

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Janitorial Services - Pleasant Hill Ranger District, Ozark NF
Solicitation number
12444225Q0005
Issued by

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This file is an Experience Questionnaire for a janitorial services contract with the USDA Forest Service. The document requires potential contractors to provide detailed information about their company's qualifications, including years of janitorial service experience, past performance references, key personnel details, and current contractual commitments. The solicitation is set aside for 100% small businesses under NAICS code 561720 with a size standard of $22M, specifically for janitorial services at the Pleasant Hill Ranger District office in Clarksville, AR. Quotes are due by Wednesday, April 2, 2025 at 4:30 p.m. Central Time, with all questions to be submitted no later than Thursday, March 27, 2025. Interested contractors must complete the questionnaire, which requests information on company experience, references, key personnel backgrounds, past project details, and current contract obligations, along with a certification of the information's accuracy.

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Other files

File Type Posted
Combined Synopsis Solicitation 12444225Q0005.pdf PDF
Attachment 3-Office Layout Specifications.pdf PDF
Attachment 2- Statement of work FINAL.pdf PDF
Attachment 1- Schedule of Items.xlsx XLSX spreadsheet
Attachment 5- Wage Determination Franklin County AR.pdf PDF

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Experience Questionnaire

1. Contractor Name, Address, Telephone Number, and Email Address:

3. COMPANY INFORMATION

DUNS or UEI: __________________ Small Business: Yes No

Primary NAICS Code: _____________

3. How many years of experience do you or your company have in performing janitorial services? _____________

4. Please provide references for the last three (3) companies you have performed janitorial service.

Company and Name of Person Email Address Phone Number

6. List the name (s) of the key personnel who will be serving as the Onsite Project Manager. Note this position must be under the Prime Contractor and may also serve as the cleaner/janitor.

Name and Position: ________________________________ Background Investigation Yes No

Name and Position: ________________________________ Background Investigation Yes No

Name and Position: ________________________________ Background Investigation Yes No

7. List below the experience of the key personnel who will be performing the work:

Individual’s Name Present Position Years of Experience

Type of Work

9. Past Performance - List below the projects your business has completed within the last three(3) years which are similar in scope and scale to this job:

Contract Number

Contract Amount

Location of Work Names, Telephone No., and Email of Owner/Person to contact for Project Information

Description of Project

Location of Work

Location of work

10. List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract # Dollar Amount Name, Tel, Email of Business/Govt Agency Involved

Location of work When will contract be completed?

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 capability to perform this project.

13a. CERTIFYING OFFICIAL'S NAME AND TITLE

13b. SIGNATURE 14. DATE

1 Contractor Name Address Telephone Number and Email Address:
DUNS or UEI:
Primary NAICS Code:
3 How many years of experience do you or your company have in performing janitorial services:
Company and Name of PersonRow1:
Email AddressRow1:
Phone NumberRow1:
Company and Name of PersonRow2:
Email AddressRow2:
Phone NumberRow2:
Company and Name of PersonRow3:
Email AddressRow3:
Phone NumberRow3:
Name and Position:
Name and Position_2:
Name and Position_3:
Individuals NameRow1:
Present PositionRow1:
Years of ExperienceRow1:
Type of WorkRow1:
Individuals NameRow2:
Present PositionRow2:
Years of ExperienceRow2:
Type of WorkRow2:
Individuals NameRow3:
Present PositionRow3:
Years of ExperienceRow3:
Type of WorkRow3:
Contract NumberRow1:
Contract AmountRow1:
Location of WorkRow1:
Names Telephone No and Email of OwnerPerson to contact for Project InformationRow1:
Description of Project:
Contract NumberRow1_2:
Contract AmountRow1_2:
Location of WorkRow1_2:
Names Telephone No and Email of OwnerPerson to contact for Project InformationRow1_2:
Contract NumberRow1_3:
Contract AmountRow1_3:
Location of workRow1:
Names Telephone No and Email of OwnerPerson to contact for Project InformationRow1_3:
Description of ProjectRow1:
Contract Row1:
Dollar AmountRow1:
Name Tel Email of BusinessGovt Agency InvolvedRow1:
Location of workRow1_2:
When will contract be completedRow1:
Contract Row2:
Dollar AmountRow2:
Name Tel Email of BusinessGovt Agency InvolvedRow2:
Location of workRow2:
When will contract be completedRow2:
Contract Row3:
Dollar AmountRow3:
Name Tel Email of BusinessGovt Agency InvolvedRow3:
Location of workRow3:
When will contract be completedRow3:
Contract Row4:
Dollar AmountRow4:
Name Tel Email of BusinessGovt Agency InvolvedRow4:
Location of workRow4:
When will contract be completedRow4:
13a CERTIFYING OFFICIALS NAME AND TITLE:
13b SIGNATURE:
14 DATE:
Description of Project_2:
Description of Project_3:
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Check Box7: Off
Check Box8: Off
Check Box9: Off

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