C04_Attch 5 -Past Performance Questionnaire.pdf
PDF 91 KB Posted
- Attached to
- INF South Zone Districts Janitorial
- Solicitation number
- 127EAY26Q0064
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire form required by the USDA Forest Service for federal contract solicitations, referenced in FSH 6309.31 and 41 USC 1.
The form requires contractors to provide comprehensive information about their qualifications and historical performance. Respondents must identify their business type (company, corporation, co-partnership, individual, or non-profit organization) and document their years of experience in the relevant line of work and contracting history, distinguishing between prime contractor and subcontractor experience. The questionnaire requires listing all projects completed within the past three years, including contract amounts, project types, completion dates, and owner/contact information for reference verification. Contractors must disclose any instances of failed contract completion and provide detailed explanations if applicable. A certification section requires the certifying official to attest that all statements are complete and correct to the best of their knowledge and that named references are authorized to provide verification information to the Forest Service regarding the contractor's capability to perform the project. The form includes a remarks section for additional explanations and can be supplemented with attached sheets as needed. The document is identified with solicitation number 127EAY26Q0064.
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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
127EAY26Q0064
Attch 5
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