C04_Attch 4 -Past Performance Questionnaire.pdf
PDF 158 KB Posted
- Solicitation number
- 127EAY26Q0095
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Past Performance Questionnaire template used to evaluate contractor capability and track record for solicitation purposes.
The form requires contractors to provide comprehensive background information including company name, address, and telephone number; business structure (company, corporation, co-partnership, individual, or non-profit organization); and years of experience in both the specific line of work and general contracting as either prime or subcontractor. Contractors must list all projects completed within the last three years, documenting contract amount, project type, completion date, and owner/contact information for reference verification. The questionnaire also requires contractors to disclose any instances of incomplete work, with explanation of reasons if applicable. Additionally, contractors must certify under penalty of law that all statements are complete and accurate, and authorize the Forest Service to contact named references to verify capability to perform the project. The form references FSH 6309.31 and 41 USC 1 and is identified as Attachment 4 to solicitation 127EAY26Q0095.
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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
127EAY26Q0095
Attch 4
File details come from the government source that posted it. Updated .