B012_Blank_Past_Performance_Questionnaire.pdf
PDF 121 KB Posted
- Attached to
- EDIS: REPAIR STAFF LOT GATE & FENCE
- Solicitation number
- 140P4526Q0039
About this file
This is a Past Performance Questionnaire issued by the National Park Service for use by contractors responding to a solicitation.
The form requires contractors to provide company information including name, DUNS number, address, phone, fax, and business type (company, co-partnership, corporation, individual, or non-profit organization). Contractors must disclose years of experience in the type of work requested, years as a prime contractor, and years as a sub-contractor. The form mandates submission of three projects completed within the last five years that are similar in nature to the proposed service, including contract amounts, project type, completion dates, and complete reference contact information (name, address, email, and telephone number). Contractors must also disclose any failure to complete awarded work and whether any work was completed under performance or payment bonds, with specification of location and reason if applicable.
The form includes a separate "Past Experience & References" section that requires detailed information for up to three contracts or work experiences. For each experience entry, contractors must provide the contract or work type, contract number if applicable, total contract value, the agency or firm for which work was performed, contact person information (name, telephone, email), work period (month/year began and ended), and a brief description of duties performed. All handwritten responses must be legible. The completed form must be submitted via email to Nathan_a_Jones@nps.gov. Submission of this form is mandatory for all quoters to receive consideration.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Image_(1).jpg | JPG image | |
| B08_EDIS-140P4526Q0039_Solicitation_Repair_Staff_lot_Gate_Fence.pdf | ||
| B12-Blank_Technical_Questionnaire.pdf | ||
| Image_(6).jpg | JPG image | |
| Sol_140P4526Q0039.pdf | ||
| Image_(3).jpg | JPG image | |
| A04-SOW_-_EDIS_Staff_Lot_Gate_and_Fence.pdf | ||
| B03-_WAGE_DETERMINATION_SAM.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .