B08_PAGR_Cyclic_Rehab_Past_Performance_Questionnaire.pdf
PDF 123 KB Posted
- Attached to
- PAGR MEK SURFACE REHAB Federal contract opportunity
- Solicitation number
- 140P4526Q0022
About this file
This is a Past Performance Questionnaire and References form for RFQ 140P4526Q0022 issued by the National Park Service for Cyclic Surface Rehabilitation work. The form is mandatory for all quoters seeking consideration and must be completed and returned to Roselyn Sessoms at roselyn_sessoms@ios.doi.gov.
The questionnaire requires contractors to provide company information including business type, DUNS number, and contact details, along with years of experience in the requested work type and contracting history as both prime and subcontractors. Contractors must submit documentation of three completed projects within the last five years that are similar in size and complexity to the work outlined in the Technical Provisions. For each project, contractors must disclose the contract amount, project type, completion date, and reference contact information including name, telephone number, and email address. The form also requires disclosure of any failed contract completions or work completed under performance or payment bonds, with explanation of circumstances if applicable. Handwritten responses must be legible, and additional space may be duplicated as needed. All statements are made under certification by the contractor's authorized official, who must sign in ink and certify that named references are authorized to provide information to verify the contractor's capability to perform the project. Past performance experience may constitute a combination of up to two contracts of similar scope.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140P4526Q0022_Amd_0002.pdf | ||
| B09_MEK_Surface_Rehab_-_Questions_and_Answers_0002.docx | DOCX document | |
| Sol_140P4526Q0022_Amd_0001.pdf | ||
| Sol_140P4526Q0022.pdf | ||
| A04_PAGR_256131_20250328_Addistone_SOW.pdf | ||
| B03_WD_NJ20260002_013026.pdf | ||
| PAGR_256131_MEK_Surface_Rehab_Price_Schedule.docx | DOCX document | |
| B08_Attachment_5_Subcontracting_Percentage_Worksheet.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
RFQ:140P4526Q0022 PAGR – CYCLIC SURFACE REHABILITATION
POINT OF CONTACT: ROSELYN SESSOMS, roselyn_sessoms@ios.doi.gov
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: roselyn_sessoms@ios.doi.gov
File details come from the government source that posted it. Updated .