C04_Attch 4 -Past Performance Questionnaire.pdf
PDF 124 KB Posted
- Attached to
- Palomar Ranger District Janitorial
- Solicitation number
- 127EAY26Q0094
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Past Performance Questionnaire form used to evaluate contractor qualifications and historical performance.
The form requires contractors to provide company information including business type (company, corporation, co-partnership, individual, or non-profit organization) and contact details. Contractors must document their experience in the relevant line of work and specify years of experience as prime contractors and subcontractors. The questionnaire requests a detailed list of projects completed within the past three years, including contract amounts, project types, completion dates, and owner contact information for reference verification. Contractors must disclose whether they have ever failed to complete awarded work and, if applicable, explain the circumstances. The form includes a certification section where the certifying official must attest under penalty of perjury that all statements are complete and accurate and that named references are authorized to provide verification of the contractor's capability to perform the project. The form references FSH 6309.31 and 41 USC 1 as applicable authorities and is identified as Attachment 4 to solicitation 127EAY26Q0094.
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Text version
USDA – Forest Service
PAST PERFORMANCE QUESTIONNAIRE
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
2. SUBMITTED TO (office Name and Address)
3. BUSINESS
Company Co-partnership Corporation Individual Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years of experience in contracting have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
CONTRACT
AMOUNT TYPE OF PROJECT
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7a. Have you ever failed to complete any work awarded to you? Yes No 7b. If “Yes” to Item 8a type of project and reason(s) why:
8. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
9a. CERTIFYING OFFICIAL’S NAME AND TITLE
b. SIGNATURE (Sign in ink) 10. DATE
127EAY26Q0094
Attch 4
File details come from the government source that posted it. Updated .