Attachment_5_Past_Experience_Questionnaire.doc
DOC document 36 KB Posted
- Solicitation number
- 140F0422R0006
About this file
This document is a past experience questionnaire for contractors interested in the solicitation for vegetative planting on North Breton Island in Louisiana. The questionnaire requests information on the contractor's general business details including date established and officers. It also asks for descriptions of up to three past or current contracts including the contracting agency or company, point of contact, contract number, value, scope of work, role as prime contractor or subcontractor, any subcontracted work, period of performance, completion dates, and any quality, delivery, or safety issues encountered. The related federal contract opportunity is solicitation number 140F0422R0006 issued by the Department of the Interior Fish and Wildlife Service for vegetative planting on North Breton Island National Wildlife Refuge in Louisiana. Interested contractors must complete this past experience questionnaire to be considered for the contract award.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PAST EXPERIENCE QUESTIONNAIRE
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
Company President:
Vice President:
Dun & Bradstreet Number:
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Does company have GSA contract? Yes / No
If so GSA contract(s) number:_________________________________________________
Is product offered on schedule? Yes / No Complete and submit the information requested on the next pages 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract:
Contracting Agency or Company:
Point of Contact:
Telephone Number:
Contract Number:
Contract/Subcontract Amount: $
Project/Product Title and Delivery Location:
General Scope of Project:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Period of Performance/Delivery Days: days Scheduled Completion/Delivery Date:
Actual Completion/Delivery Date:____
Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Delivery, Quality Control or Safety Problems encountered (if any):
How were the problems resolved?
b. Second Contract:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
c. Third Contract:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
4. Certification of Past and Present Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:_________________ Email:______________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .