B08_Past_Performance_Questionnaire_GATE_SIU_Water_Main.pdf
PDF 362 KB Posted
- Attached to
- GATE-EMERGENCY REPAIRS-MILLER FIELD Federal contract opportunity
- Solicitation number
- 140P4526Q0015
About this file
This is a Past Performance Questionnaire and References form for RFQ 140P4526Q0015 concerning GATE Water Main Repairs at Miller Field, Staten Island, NY, issued by the National Park Service.
All quoters must complete this form to receive consideration. The questionnaire requires contractors to provide company information including business type (company, co-partnership, corporation, individual, or non-profit organization), years of experience in the types of work requested, and years of experience as a prime contractor and/or subcontractor. Contractors must list three projects completed within the last five years that are relevant to the proposed water main repair services, including contract amounts, project types, completion dates, and reference contact information (names, addresses, email addresses, and telephone numbers). The form also requires disclosure of whether the contractor has ever failed to complete awarded work or had work completed through performance/payment bonds, with specification of location and reason if applicable. Contractors must certify under penalty of perjury that all statements are complete and correct and that named references are authorized to provide verification information to the National Park Service. The completed form must be returned via email to the point of contact, Roselyn Sessoms, at roselyn_sessoms@ios.doi.gov. Reference information must be legible if handwritten, and past performance may consist of a combination of up to two contracts similar in size and complexity to those in the technical provisions.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140P4526Q0015_Amd_0001.pdf | ||
| A04_GATE_340516_Project_Specifications_Attachments.pdf | ||
| B08_GATE_340516_Contract_Price_Schedule.xlsx | XLSX spreadsheet | |
| Sol_140P4526Q0015.pdf | ||
| B03_WD_NY20260003_010302026.pdf |
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Text version
PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
RFQ:140P4526Q0015 – GATE Water Main Repairs/Miller Field, Staten Island, NY
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:
140P4526Q0015
POINT OF CONTACT: ROSELYN SESSOMS, roselyn_sessoms@ios.doi.gov
RFQ:140P4526Q0015 – GATE Miller Field Water Main Repairs, Staten Island, NY
140P4526Q0015
POINT OF CONTACT: ROSELYN SESSOMS, roselyn_sessoms@ios.doi.gov
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 #: ____________________________________________
RFQ:140P4526Q0015 – GATE Miller Field Water Main Repairs, Staten Island, NY
140P4526Q0015
POINT OF CONTACT: ROSELYN SESSOMS, roselyn_sessoms@ios.doi.gov
E-mail address: ____________________________________________
Month/Year work began: Month/Year work ended: ________________________________________
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: ____________________________________________
Month/Year work began: Month/Year work ended: ________________________________________
Brief description of duties:
Return form to:
Email:
roselyn_sessoms@ios.doi.gov mailto:linda_richardson@nps.gov
File details come from the government source that posted it. Updated .