Attachment 7_PastPerformanceQuestionnaire.pdf

CONSTRUCTION RFQ Solicitation # 1240LU26Q0013 Park Lake Dam Rehabilitation

Rev. 11/5/25

USDA Forest Service

PERFORMANCE QUESTIONNAIRE

Instructions: See Box 12, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name and Address)

3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience as a (a) prime contractor ______ and/or (b) sub-contractor ______ has your firm performed work similar to this solicitation?

6. List below the projects your business has completed within the last three years:

Contract Amount

Type of Project Date Completed

Name, & Telephone No. of Owner/Person to Contact for Project Information

7. List below your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Number

Dollar Amt.

of Award

Name, Address, and Telephone No. of Business/Government Agency Involved

Awarded (Units)

Percent Completed

Date

Complete

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No

8b. Has your work ever been completed by performance bond? [ ] Yes [ ] No

8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No

8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

PERFORMANCE QUESTIONNAIRE CONTINUED

9. Provide a narrative of your technical approach to performing work for this contract:___________________________________

10. Estimate progress rates for work items:

Item No.

Work Description Estimated No. of Days

Estimated Hours per Day Date of Start End Date

1 Mobilization

2 Preconstruction

3 Clearing and Grubbing

4 Dewatering July 15 or later

5 Deconstruction 6 Reconstruction 7 Seismic Foundation

Improvement

8 Hydraulic Seepage Control Barrier

9 Road Reconstruction 10 Reclamation 11 Saddle Dike 12 Misc.

11. List below the experience of the principal individuals of your business: (Who will directly be involved in this contract?)

Individual’s Name Present Position Years of Experience

Magnitude and Type of Work

12. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO

SUCCESSFULLY COMPLETE THIS PROJECT.

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.

13a. CERTIFYING OFFICIAL’S NAME AND TITLE

b. SIGNATURE (Sign in ink) 13. DATE