Blank_Past_Performance_Questionnaire.pdf
PDF 124 KB Posted
- Attached to
- EDIS CONSERVE 21 HISTORIC LAMPSHADES
- Solicitation number
- 140P4523Q0063
About this file
This document contains a past performance questionnaire and references form for contractors to complete in response to solicitation number 140P4523Q0063 from the Department of the Interior National Park Service. The solicitation seeks to conserve 21 historic lampshades. Contractors must provide details on three similar past projects from the last five years, including contract amounts, dates, agency clients, and references. They must also disclose any past failures to complete work or bonds issued. The completed form and references will be considered to evaluate the contractors' experience and capability to perform the required lampshade conservation work.
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Other files
| File | Type | Posted |
|---|---|---|
| Blank_Technical_Questionnaire.pdf | ||
| A04_RFPTextile_Lampshades_Final_doc.pdf | ||
| Contractor_Monitoring_SOP_Revised_(FINAL).pdf | ||
| A06_Lampshade_List.pdf | ||
| Sol_140P4523Q0063.pdf |
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Text version
0040620106 EDIS 21 HISTORIC LAMPSHADES
RFQ 140P4523Q0063
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: linda_richardson@nps.gov mailto:linda_richardson@nps.gov
Type of Business:
File details come from the government source that posted it. Updated .