B012_Blank_Past_Performance_Questionnaire.pdf
PDF 121 KB Posted
- Attached to
- VAMA PREPARE LABOR AND LAND STUDY
- Solicitation number
- 140P4524Q0072
About this file
This document is a Past Performance Questionnaire that requests information about a contractor's prior experience. The questionnaire asks the contractor to provide details on the type of business, number of years of relevant experience, and completed projects within the last 5 years that are similar in scope to the current solicitation. The contractor must list 3 relevant past projects, including the contract amount, project type, completion date, and contact information for references. The questionnaire also asks if the contractor has ever failed to complete any awarded work or had work completed by a performance/payment bond. The contractor must certify that the information provided is accurate.
The related federal contract opportunity is for the Vanderbilt Mansion National Historic Site to prepare a labor and land study. The solicitation number is 140P4524Q0072, and the opportunity is being issued by the Department of the Interior National Park Service Northeast Region.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Sol_140P4524Q0072.pdf | ||
| B08_Service_RFQ_VAMA_40667512.pdf | ||
| A04-SOW_VAMA_EOA_Labor_History_REVISED.pdf | ||
| Blank_Technical_Questionnaire.pdf | ||
| B03-WD_2015-5777.pdf | ||
| Bid-Price_Schedule.pdf |
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Text version
Past Performance Questionnaire
Contractor Name: Duns #
Address: City: State: Zip:
Phone Number: Fax Number:
Type of Business:
_____Company ____Co-partnership ______Corp._____ Individual ____Non-Profit Org.
How many years do you or your firm has in the types of work requested by this solicitation?
_________________year(s).
How many years experience in contracting have you or your business had as a Prime Contractor? _________year(s) and/or Sub-contractor: _______(years)
List below the three (3) projects your business has completed within the last five (5) years of the proposed service requested by this solicitation, include the contract amount, the type of project, date completed and your reference contact name, address, email address and telephone number: (SEE ATTACHED SHEET)
Have you ever failed to complete any work awarded to you? ______Yes _____No
Has work ever been completed by performance/payment bond? ______Yes ______No
If “Yes” to either item, specify location and reason:
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 National Park Service with any information needed to verify my capability to perform this project.
Certifying Official Name and Title:
Signature (Sign in Ink):
Date:
PAST EXPERIENCE & REFERENCES
REFERENCES:
This form must be completed by all quoters in order to receive consideration. If additional space is needed, this form may be duplicated as necessary. List any current or past experience which is pertinent to this position. Past performance and experience may be a combination of up to two contracts similar in size and complexity to those stated in the Technical Provisions and work experience in similar positions, performing duties similar in nature and complexity to the required services. Include (separately) details of any training which would enable you to better perform the work outlined in the specifications. Reference information should include a point-of-contact's name, telephone number and e-mail address. (IF
HANDWRITTEN, MUST BE LEGIBLE)
Experience No. 1
Contract/Work type: ____________________________________________
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed: ____________________________________________
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended: ________________________________________
Brief description of duties:
Experience No. 2
Contract/Work type: ____________________________________________
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed: ____________________________________________
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Brief description of duties
Experience No. 3
Contract/Work type: ____________________________________________
Contract Number (if applicable): ____________________________________________
Total Contract Value: __________________________________________
Agency/firm for who work was performed: ____________________________________________
Contact person at the site: Telephone #: ____________________________________________
E-mail address: ____________________________________________
Brief description of duties:
Return form to:
Email: Nathan_a_Jones@nps.gov
Type of Business:
File details come from the government source that posted it. Updated .