B08_Past_Performance_Questionnaire.doc
DOC document 46 KB Posted
- Attached to
- SAFETY & ENERGY EFFICIENCY RETROFITS
- Solicitation number
- 140L3623Q0032
About this file
This document is a past performance questionnaire to be submitted with quotes for solicitation number 140L3623Q0032 from the Department of the Interior Bureau of Land Management seeking safety and energy efficiency retrofits. Contractors must provide details on their relevant experience, including the number of years performing similar work, time as a prime or subcontractor, and references and descriptions for completed projects from the past three years involving duties and technical complexity comparable to those required here. Concurrent contract commitments must also be listed along with certifications of completeness and accuracy and an authorized signature.
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Text version
Past Performance Questionnaire
(THIS MUST BE COMPLETED AND SUBMITTED WITH YOUR QUOTE)
Contractor Name:______________________________________________________________________ Address:__________________________________ City:_______________ State: _____ Zip:________ Phone Number: ____________________ SAM Entity Number (UEI): ____________________________ Type of Business:
_____Company ____Co-partnership ______Corp._____ Individual ____Non-Profit Org.
1. How many years of RELEVENT experience do you have and/or your company have regarding the types of work requested by this solicitation?
-You__________________ -Your Company__________________
2. How many years of experience in contracting does your company have as a Prime Contractor and/or a Sub-Contractor:
-Prime_________________ -Sub-Contractor__________________
3. List below projects your business has completed within the last three years. Include the contract number and amount; the type of project; the date completed and a reference contact name and telephone number for each project.
Note: Past Projects must be relevant to the requirements of this solicitation in terms of duties performed, and the technical/complexity aspects of the duties required. Projects listed that are not relevant to this solicitation and its requirements will not be considered. (attach separate page if additional room is needed)
4. List all contract commitments you have that will run concurrently with the work requested in this solicitation. Include name, address, telephone number, start and finish date.
5. Have you ever failed to complete any work awarded to you? ______Yes _____No
6. Has work ever been completed by performance 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 Bureau of Land Management with any information needed to verify my capability to perform this project.
Certifying Official Name and Title :
Authorized Signature (Sign in Ink):
Date:
File details come from the government source that posted it. Updated .