B08_Attachment_5_PPQ_X5313_Steam_Generator_STEA.pdf
PDF 126 KB Posted
- Attached to
- STEA - X5313 STEAM GENERATOR
- Solicitation number
- 140P4526Q0031
About this file
This is a Past Performance Questionnaire for federal contract opportunity 140P4526Q0031 related to STEA X5313 Steam Generator work.
The questionnaire is issued by the National Park Service and directed to the point of contact Mary Hallmon (mary_hallmon@ios.doi.gov). Contractors must provide company information including contractor name, DUNS number, address, phone, fax, and business type (company, co-partnership, corporation, individual, or non-profit organization). The form requires contractors to document years of experience in the types of work solicited, years as a prime contractor, and years as a subcontractor. Contractors must list three completed projects from the past five years that are similar in size and complexity to the solicitation requirements, including contract amount, project type, completion date, and reference contact information (name, address, email, and telephone). The questionnaire includes yes/no questions regarding failure to complete awarded work and whether work has been completed under performance or payment bonds; affirmative answers require specification of location and reason. The form contains a certification section requiring the certifying official's name, title, signature in ink, and date, certifying that all statements are complete and correct and that named references are authorized to provide verification information to the National Park Service. Completed forms must be submitted via email to mary_hallmon@ios.doi.gov. The form includes an attached detailed past experience and references section where contractors provide up to three experiences with contract type, contract number, total contract value, agency/firm information, site contact details, work dates, and brief duty descriptions.
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Text version
140P4526Q0031
POINT OF CONTACT: MARY HALLMON mary_hallmon@ios.doi.gov
STEA X5313 Steam Generator
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:
mailto:mary_hallmon@ios.doi.gov
STEA X5313 Steam Generator
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 #: ____________________________________________
STEA X5313 Steam Generator
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 mailto:mary_hallmon@ios.doi.gov
Type of Business:
File details come from the government source that posted it. Updated .