B08_Attachment_3_PPQ_Conserve_Stained_Glass_EDIS.pdf
PDF 126 KB Posted
- Attached to
- EDIS CONSERVE TOP PRIORITY STAINED GLASS
- Solicitation number
- 140P4526Q0029
About this file
This is a Past Performance Questionnaire for federal contract solicitation 140P4526Q0029, EDIS Conserve-Stained Glass, issued by the National Park Service under the Department of Interior.
Contractors responding to this solicitation must complete the questionnaire to receive consideration. The form requires contractors to provide their business information, including company type, years of experience in the requested work type, and contracting history as either prime contractors or subcontractors. Contractors must list three projects completed within the last five years that are similar in scope and complexity to the proposed services, including contract amounts, project types, completion dates, and complete reference contact information (name, address, email, and telephone). The questionnaire also requires contractors to disclose any failures to complete awarded work and any instances where work was completed under performance or payment bonds, with explanations if applicable. The form includes detailed reference sections requiring up to three separate experiences to be documented, with each entry requiring contract/work type, contract number, total contract value, performing agency or firm, site contact person with telephone number and email, work dates, and a brief description of duties. All submissions must include a certification signed in ink by the certifying official attesting to the accuracy of statements. Completed forms should be submitted via email to mary_hallmon@ios.doi.gov. If handwritten, all entries must be legible.
View the file
Other files
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
140P4526Q0029
POINT OF CONTACT: MARY HALLMON mary_hallmon@ios.doi.gov EDIS Conserve-Stained Glass
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: mary_hallmon@ios.doi.gov
Type of Business:
File details come from the government source that posted it. Updated .