C04d_Performance Relevancy Questionnaire.pdf

Exhibit A: PERFORMANCE RELEVANCY QUESTIONNAIRE Provide the following information requested in this format for each of the projects/contracts being described.

Projects may be ongoing and cannot have been completed any later than 3 years prior to the to this issue date.

Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify.

Use as much space as required. OFFEROR SHOULD PLACE THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE.

INSTRUCTIONS: Mark "X" in appropriate boxes. Complete this form and return it with your Quote/Proposal.

CONTRACTOR NAME, ADDRESS & TELEPHONE Reference the Solicitation Number:

1. How many years do you or your firm have in the line of work contemplated by this solicitation?

2. How many years’ experience in contracting have you or your business had as a prime contractor?

3. How many years’ experience in contracting have you or your business had as a sub-contractor?

4. Is your Quote (Offer) being performed by you or your Company as the prime contractor? Yes No

5. If you or your company are not the prime contractor, write in the Company Name, Employee Names and telephone numbers of the personnel who will be performing this service below. Note: Personnel who are to perform these services must be provided at the time of your offer listed within your Quote or Proposal. Refer to the documentation for specific details concerning Insurance Coverage and Key Personnel.

PART 1 - PAST / CURRENT PROJECTS

List below up to 5 projects your business has completed within the last 3 years for services similar in scope to the solicitation:

Contract Amount Type of Project Date Completed Name Address & Telephone No. of Person to Contact for Project Information.

List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract No. Dollar Amount of Project

Name, Address & Phone No. of Business Govt./Agency

Awarded (Units)

Completed

Date Contract Completed

6. Have you ever failed to complete any work awarded to you? Yes No

7. Has work ever been completed by performance bond? Yes No

8. If "Yes" to either item above specify location(s) and reason(s) why:

PART 2 – SPECIALIZED EXPERIENCE – Answer the following questions in a Technical Proposal attached to your offer, if Applicable.

1. Describe the specific elements of the work performed by your firm.

2. Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on Forest Service projects.

3. Address any technical areas about this project you consider uniquely relevant to this solicitation.

4. Point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number, email address and facsimile number, if available.

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 Forest Service with any information needed to verify my capability to perform this project.

Certifying Official's Printed Name and Title Signature Date