Attachment F- Past Performance Questionnaire Experience FILLABLE.pdf
PDF 155 KB Posted
- Solicitation number
- 127EAT24Q0032
About this file
This document is an Experience Questionnaire for a federal contract opportunity. It requests information about the contractor's company, such as DUNS or UEI, small business status, years of experience, equipment, and key personnel. It also asks the contractor to list past performance projects involving loading and unloading of heavy equipment, and to provide references. The questionnaire requires the contractor to certify the accuracy of the information provided.
The related federal contract opportunity is for cleaning and minor repair of a 30' x 10' concrete water tank in the Angeles National Forest. The work includes removing debris, performing minor repairs, disinfecting the tank, and providing an inspection report with recommendations. Contractors must coordinate with the Forest Service to schedule the work, as the tank serves multiple organizational camps and access may be restricted due to the nearby Bridge Fire. Proposals are due by 3 p.m. Mountain time on Friday, September 27, 2024.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C Spalling Area A of JLT.jpg | JPG image | |
| Attachment D Spalling Area B of JLT.jpg | JPG image | |
| Attachment G-SOW_JacksonLakeWaterTankCleaning.pdf | ||
| Attachment A Water Tank Structure.jpg | JPG image | |
| RFQ Jackson Lake Water Tank Cleaning and Repairs 127EAT24Q0032 1719857 (1).docx | DOCX document | |
| Attachment B Roof of JLT.jpg | JPG image | |
| Attachment E - Wage Determination.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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