C04_ATTCH 9_Past Performance Questionnaire.pdf
PDF 57 KB Posted
- Attached to
- Lake Tahoe Basin Janitorial
- Solicitation number
- 127EAY26Q0143
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire form used by the USDA Forest Service to evaluate contractor qualifications and experience for solicitation opportunities.
The form requires contractors to provide comprehensive background information including company name, address, and telephone contact; business type (company, corporation, co-partnership, individual, or non-profit organization); and years of experience in the relevant line of work. Contractors must document their contracting experience as both prime contractors and subcontractors. The questionnaire requires detailed listings of projects completed within the preceding three years, including contract amounts, project types, completion dates, and owner/contact information for reference verification. Additionally, contractors must disclose whether they have ever failed to complete awarded work, and if so, provide explanations for the project type and reasons for non-completion. The form includes a remarks section for additional information and attachments as needed. Certification by the contractor's authorized official is required, with the certifier's name, title, signature in ink, and date. The form references FSH 6309.31 and 41 USC 1 and is identified as Attachment 9 to solicitation 127EAY26Q0143.
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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
127EAY26Q0143 Attch 9
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