Exhibit C - PERFORMANCE RELEVANCY QUESTIONNAIRE FILLABLE.pdf

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USDA Forest Service - Arkansas OZARK NORTH Road Construction MATOC
Solicitation number
12445123R0005
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Road Construction Services

Exhibit B: 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: If extra space is needed use the reverse. Mark "X" in appropriate boxes.

CONTRACTOR NAME, ADDRESS & TELEPHONE/Unique Sam ID

How many years do you or your firm have in the line of work contemplated by this solicitation ______? How many years experience in contracting have you or your business had as a (a) prime contractor _____ and/or (b) sub-contractor _____?

PART 1 - PAST / CURRENT PROJECTS

List below up to 5 projects your business has completed within the last 3 years 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

Have you ever failed to complete any work awarded to you? Yes ( ) No ( ) Has work ever been completed by performance bond? Yes ( ) No ( ) If "Yes" to either item above specify location(s) and reason(s) why:

PART 2 – SPECIALIZED EXPERIENCE – For each of the projects listed above, address the following comments on a separate sheet:

a) Describe the specific elements of the work performed by your firm.

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

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

d) Point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number and facsimile number. Email address is also desired.

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

Solicitation:

Forest/State:

CONTRACTOR NAME ADDRESS TELEPHONEUnique Sam ID:
How many years experience in:
andor b subcontractor:
undefined:
Contract AmountRow1:
Type of ProjectRow1:
Date CompletedRow1:
Name Address Telephone No of Person to Contact for Project InformationRow1:
Contract AmountRow2:
Type of ProjectRow2:
Date CompletedRow2:
Name Address Telephone No of Person to Contact for Project InformationRow2:
Contract AmountRow3:
Type of ProjectRow3:
Date CompletedRow3:
Name Address Telephone No of Person to Contact for Project InformationRow3:
Contract AmountRow4:
Type of ProjectRow4:
Date CompletedRow4:
Name Address Telephone No of Person to Contact for Project InformationRow4:
Contract AmountRow5:
Type of ProjectRow5:
Date CompletedRow5:
Name Address Telephone No of Person to Contact for Project InformationRow5:
Contract NoRow1:
Dollar Amount of ProjectRow1:
Name Address Phone No of Business GovtAgencyRow1:
Awarded UnitsRow1:
CompletedRow1:
Date Contract CompletedRow1:
Contract NoRow2:
Dollar Amount of ProjectRow2:
Name Address Phone No of Business GovtAgencyRow2:
Awarded UnitsRow2:
CompletedRow2:
Date Contract CompletedRow2:
Contract NoRow3:
Dollar Amount of ProjectRow3:
Name Address Phone No of Business GovtAgencyRow3:
Awarded UnitsRow3:
CompletedRow3:
Date Contract CompletedRow3:
Contract NoRow4:
Dollar Amount of ProjectRow4:
Name Address Phone No of Business GovtAgencyRow4:
Awarded UnitsRow4:
CompletedRow4:
Date Contract CompletedRow4:
If Yes to either item above specify locations and reasons why:
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