ATTACHMENT D - PAST PERFORMANCE QUESTIONNAIRE.docx
DOCX document 22 KB Posted
- Solicitation number
- 12444625Q0006
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire template attachment (Attachment D) for solicitation 12444625Q0005 related to snowplow services at the Superior National Forest Isabella Work Station in Minnesota.
The questionnaire requires contractors to provide detailed business information including years of experience as prime and subcontractors, relevant completed projects from the last 3 years, concurrent contractual commitments, organizational capacity details (employee counts, equipment, facilities), and key personnel experience. Contractors must also submit narratives describing their operational plan and quality control measures. The form specifically requests information about employees certified in Volume Estimation per Attachment B SOW requirements. The questionnaire includes sections for documenting any previous failed contracts or performance bond completions, and requires certification of accuracy from the contractor.
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Text version
Solicitation:12444625Q0005 Project: Superior NF – Isabella MN - Snowplow
EXPERIENCE AND CAPABILITY QUESTIONNAIRE
Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.
Please list NA for inapplicable items.
| 1. Contractor's Name, Address & Telephone Number |
| 2. Type of Business |
____ Company
____ Corporation
____ Non-profit Organization
____ Co-partner
____ Individual
3. How many years of experience do you have in this line of work? ___________________
4. How many years of experience as a prime contractor? _________ subcontractor? ________
5. List the relevant projects your business has completed in the last 3 years.
Contract Amount
| Type of Project |
| Date |
Completed Name and Telephone Number to Contact For Information
6. List contractual commitments running concurrently with the work contemplated by this soliciation.
Contract Number Contract Amount
| Type of Project |
| Est. Date of |
Completion Name and Telephone Number to Contact For Information
7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no 7b. Has work ever been completed by performance bond? ____ yes ____ no 7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
8. Organization that will be available for this project:
| a. | Minimum No. of employees: _______________ Maximum No. of employees: ________________ |
| b. | Are employees regularly on your payroll? ____ yes ____ no |
| c. | Specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract: |
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: __________________________ Maximum progress rate: _____________________
9. List the employees that would be assigned to perform services at the work site on this contract and their experience. Specifically list emplyees who are certified with the forest in Volume Estimation in acccordance with Attachment B SOW All Units, Section H:
| Individual's Name |
| Present Position |
| Years Experience |
| Type of Work |
10. Please provide a narative which describes your anticipated plan of operations. If the space below is not adequate for response please provide your response on an additional page(s).
11. Please provide a narrative which describes your quality control plan. Please use additional pages if needed.
12. Remarks: Additional pages may be added to provide additional information in this section.
CERTIFICATION: I certify that all of the statements made above 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.
Signature Title Date
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