Attachment B Past Performance Questionnaire Experience FILLABLE.pdf
PDF 155 KB Posted
- Attached to
- Elevator Maintenance Services Federal contract opportunity
- Solicitation number
- 127EAT24Q0042
- Issued by
- Department of Agriculture Forest Service
About this file
This document is a Past Performance Questionnaire that is part of the federal contract opportunity for Elevator Maintenance Services at the USDA Forest Service's Angeles National Forest Supervisor's Office.
The questionnaire collects information about the contractor's company, including years of experience, use of subcontractors, equipment and key personnel, as well as details on the contractor's past performance on similar contracts involving loading and unloading of heavy equipment. The contractor must also list any concurrent contractual commitments. The completed questionnaire must be certified by an authorized official.
The related federal contract opportunity is for a base year and 4 option years of elevator maintenance services. The solicitation number is 127EAT24Q0042 and it is being issued by the Department of Agriculture Forest Service.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment B Past Performance Questionnaire -UPDATED.pdf | ||
| Amendment A0002 127EAT24Q0042.pdf | ||
| Attachment E Wage Determination 1986-0431 Rev 60 dated 12_26_23.pdf | ||
| Amendment A0001 127EAT24Q0042.pdf | ||
| 127EAT24Q0042 Elevator Maintenance Service.pdf | ||
| Attachment D Angeles National Forest Supervisor Office Floor Plan.pdf | ||
| Attachment C Statement of Work.pdf | ||
| Attachment A Wage Determination 2015-5613 Rev 25 dated 12_26_23.pdf |
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Text version
Experience Questionnaire
1. Contractor Name, Address, Telephone Number, and Email Address:
2. 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 this work? _____________
4. Will you be using a subcontractor? Yes No
5. Please provide references for the last three (3) company where you performed
Company and Name of Person Email Address/Phone # Description of Work
6. Describe the equipment you will be using in the performance of this contract:
7. Do you have experience working with cranes to load/move heavy equipment? Yes____ No __________
8. What types of equipment do you have experience working with that is relevant to this contract?
9. 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
10. Past Performance - List below the projects your business has completed within the last five (5) years that involved included loading and unloading of heavy equipment such as precast concrete structures/ vault toilets?
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
11. 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 this work: |
| 5 Please provide references for the last three 3 company where you performed: |
| Company and Name of PersonRow1: |
| Email AddressPhone Row1: |
| Description of WorkRow1: |
| Company and Name of PersonRow2: |
| Email AddressPhone Row2: |
| Description of WorkRow2: |
| Company and Name of PersonRow3: |
| Email AddressPhone Row3: |
| Description of WorkRow3: |
| 6 Describe the equipment you will be using in the performance of this contract 1: |
| 6 Describe the equipment you will be using in the performance of this contract 2: |
| undefined: |
| undefined_2: |
| 8 What types of equipment do you have experience working with that is relevant to this contract: |
| Individuals NameRow1: |
| Present PositionRow1: |
| Years of ExperienceRow1: |
| Type of WorkRow1: |
| 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: |
| Description of ProjectRow1: |
| Description of Project_2: |
| Contract Row1: |
| Dollar AmountRow1: |
| Name Tel Email of BusinessGovt Agency InvolvedRow1: |
| Location of workRow1: |
| 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: |
| 13a CERTIFYING OFFICIALS NAME AND TITLE: |
| 13b SIGNATURE: |
| 14 DATE: |
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| Check Box2: Off |
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| Check Box4: Off |
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