Attachment 5 Relevant Experience Past Performance Questionnaire.pdf
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- Attached to
- Florida - Reforestation/NNIS BPA Federal contract opportunity
- Solicitation number
- 12444122R0012
- Issued by
- Department of Agriculture Forest Service
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Text version
12444122R0012
ATTACHMENT 5
RELEVANT EXPERIENCE/PAST PERFORMANCE QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business ____Company ____Co-Partner ____Non-profit ____Corporation ____Individual
CAGE: UEI:
3. How many years experience do you have in this line of work_____Years
4. How many years experience as a Prime Contractor______ Subcontractor______
5. LIST OF RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST
THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included.
(i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
6a. Have you ever failed to complete any work awarded to you? ___Yes ___ No
6b. Has work ever been completed by performance bond? ___Yes ___ No
6. If "yes" to either item 6a or 6b specify location(s) and reason(s) why:
7. List the experience of the principal individuals of your business:
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References:
Company Name/Address Point of Contact Telephone number Materials/Services Provided
b. Banking Information. (please do NOT provide account information – just a point of contact and a way to reach them)
Company Name/Address Point of Contact Telephone number
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
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 Forest Service with any information needed to verify my capability to perform this project:
File details come from the government source that posted it. Updated .