B12_Past_Performance_Questionnaire.pdf
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- Solicitation number
- 140P4526R0019
About this file
This is a Past Performance Questionnaire form required by the National Park Service for contractors responding to a solicitation.
The form requests comprehensive information about a contractor's qualifications and relevant experience. Contractors must provide basic company information including name, DUNS number, address, and phone/fax details, along with business type designation (Company, Co-partnership, Corporation, Individual, or Non-Profit Organization). The form requires contractors to document years of experience in the specific work types requested by the solicitation, as well as separate experience metrics for prime contractor and subcontractor roles. Contractors must list three projects completed within the last five years that are similar in nature to the solicitation requirements, including contract amounts, project types, completion dates, and detailed reference contact information (name, address, email, and telephone number). The form includes yes/no questions regarding failure to complete awarded work and whether work was completed under performance/payment bond coverage, with space to explain any affirmative responses. All information must be certified by an authorized company official through signature and dated attestation, confirming the accuracy of statements and authorizing the National Park Service to contact references for verification purposes. Completed forms should be returned via email to nathan_a_jones@nps.gov. The document includes a supplementary "Past Experience & References" section allowing up to three detailed experience entries with fields for contract type, contract number, total value, performing agency/firm, site contact information, work dates, and duty descriptions, with a notation that handwritten entries must be legible.
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Text version
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
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
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: nathan_a_jones@nps.gov mailto:nathan_a_jones@nps.gov
Type of Business:
File details come from the government source that posted it. Updated .