B08_Attachment_4_PPQ_Replace_Bearings_and_End_Shafts_GATE.pdf
PDF 79 KB Posted
- Attached to
- GATE-REPLACE BEARINGS & END SHAFTS-WWTP
- Solicitation number
- 140P4525Q0050
About this file
This document is a Past Performance Questionnaire for a National Park Service contract (Solicitation Number 140P4525Q0050) to replace bearings and end shafts at a wastewater treatment plant (WWTP). The form requires potential contractors to provide detailed information about their business, including years of experience, type of business, and past project history. Contractors must list three projects completed within the last five years that are similar in size and complexity to the current solicitation, including contract values, work descriptions, and reference contact information.
The questionnaire requires contractors to disclose their contracting experience as prime or sub-contractors, confirm their ability to complete work, and certify the accuracy of their submitted information. Prospective bidders must complete all sections, including a certification statement, and provide legible contact details for references. The point of contact for this solicitation is Mary Hallmon, who can be reached at mary_hallmon@nps.gov, and interested contractors are expected to submit a comprehensive response demonstrating their capability to perform the gate bearing and end shaft replacement work.
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Text version
140P4525Q0050
POINT OF CONTACT: MARY HALLMON mary_hallmon@nps.gov
GATE Replace Bearings and End Shafts
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
Brief description of duties
Experience No. 3
Brief description of duties:
Return form to:
Email: mary_hallmon@nps.gov mailto:mary_hallmon@nps.gov
File details come from the government source that posted it. Updated .