B08_Attachment_3_Past_Performance_Questionnaire-TishHH3Drains.docx

Attachment 3 page 2 of 4

TECHNICAL/PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Your Company Name:

Street Address:

Email Address:_____________________________________ City, State and ZIP Code:

1. GENERAL BUSINESS INFORMATION

Date Firm Organized/Established:

Is company; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]

2. PAST EXPERIENCE

a. Provide at least three examples of past experience of Construction Contractor for building drain pipelines, trenching, valves, interior trench drains, concrete, horizontal and vertical survey alignment, earthwork, demolition, and other work similar to that shown in the plans and specifications for this project.

b. Provide proof of ability to obtain bonding for the magnitude of this contract.

c. Provide proof of state registration of specialty trade contractors for performing work in Oklahoma on this contract.

3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS

Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.

a. First Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Project:

Your Role (General Contractor [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____

b. Second Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Project:

Your Role (General Contractor [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____

c. Third Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Project:

Your Role (General Contractor [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____