Attachment E-Past Performance Questionnaire.pdf
PDF 94 KB Posted
- Attached to
- Portable Toilet Rentals and Pumping-Mt. Pinos Ranger District Los Padres National Forest
- Solicitation number
- 127EAT24Q0016
- Issued by
-
Department of Agriculture Forest Service
About this file
This document contains a past performance questionnaire for contractors to complete related to a portable toilet rental and pumping services contract on the Mt. Pinos Ranger District of the Los Padres National Forest. The questionnaire requests information on the contractor's experience, past projects as both a prime contractor and subcontractor, and references from previous clients that can be contacted. It requires the contractor to disclose any past failures in completing work and to certify that the responses provided are complete and correct. The related federal contract opportunity is for the contractor to supply portable toilets at specific locations on the Mt. Pinos Ranger District during periods of snowfall to accommodate increased visitation and mitigate environmental impacts. The services are needed when snow is present on the ground to support public use of the forest. The agency is the Department of Agriculture Forest Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A-Schedule of Items.pdf | ||
| Attachment C-Wage Determination.pdf | ||
| Attachment D-Locations Map.pdf | ||
| Attachment B-Statement of Work.pdf | ||
| Solicitation 127EAT24Q0016.pdf |
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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 relevant 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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