Attachment C Past Performance Questionnaire.pdf
PDF 94 KB Posted
- Attached to
- Vehicle Accident Damage Repair
- Solicitation number
- 127EAT25Q0004
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Past Performance Questionnaire from the USDA Forest Service. The questionnaire is intended to collect information about a contractor's past experience, including the number of years in the line of work, experience as a prime or subcontractor, and a list of recent projects completed. The contractor is also asked to indicate if they have ever failed to complete any awarded work. The document requires the contractor's certifying official to sign and date the form, verifying the accuracy of the information provided.
This Past Performance Questionnaire is related to a federal contract opportunity for Vehicle Accident Damage Repair, solicited by the USDA Forest Service in San Bernardino, California. The solicitation number is 127EAT25Q0004.
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Text version
USDA – Forest Service
PAST PERFORMANCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
2. SUBMITTED TO (office Name and Address)
3. BUSINESS
Company Co-partnership Corporation Individual Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years of experience in contracting have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
CONTRACT
AMOUNT
TYPE OF PROJECT
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7a. Have you ever failed to complete any work awarded to you? Yes No 7b. If “Yes” to Item 8a type of project and reason(s) why:
8. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
9a. CERTIFYING OFFICIAL’S NAME AND TITLE
b. SIGNATURE (Sign in ink) 10. DATE
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