B08_Past_Performance_Questionnaire_STEA_K2_Maintenance.pdf
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- Attached to
- STEA - K2 PYLE MAINTENANCE
- Solicitation number
- 140P4526Q0042
About this file
This is a Past Performance Questionnaire and References form for RFQ 140P4526Q0042 – STEA K2 Pyle Maintenance and Repair in Scranton, PA. The form is issued by the National Park Service and requires all quoters to complete it to receive consideration for the contract award.
The questionnaire requires contractors to provide company information including business type, DUNS number, and contact details. Contractors must document years of experience in the specific work type requested and specify experience as both prime contractors and subcontractors. The form requires submission of three past performance projects completed within the last five years that are similar in size and complexity to the solicitation requirements. For each project, contractors must provide the contract amount, project type, completion date, and complete reference contact information including name, address, email, and telephone number. Additionally, contractors must disclose any instances of failure to complete awarded work or work completed under performance or payment bonds, including location and reason for such occurrences. The form includes a certification section requiring the contracting official to sign in ink and attest that all statements are complete and correct. All completed forms must be returned via email to the point of contact, Roselyn Sessoms, at roselyn_sessoms@ios.doi.gov.
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PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
RFQ:140P4526Q0042 – STEA K2 PYLE Maintenance and Repair Scranton, PA
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:
140P4526Q0042 POINT OF CONTACT: ROSELYN SESSOMS roselyn_sessoms@ios.doi.gov
RFQ 140P4526Q0042 – STEA K2 Pyle Generator Maintenance and Repair, Scranton, PA
140P4526Q0042 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 140P4526Q0042 – STEA K2 Pyle Maintenance and Repair, Scranton, PA
140P4526Q0042 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 .