Exhibit_E-4_Past_Performance_Questionnaire.docx

DOCX document 60 KB Posted

Attached to
BLM AK EU Light Helicopter Cadastral Flight Svcs Federal contract opportunity
Solicitation number
140D8121R0008
Issued by
Department of the Interior Departmental Offices Interior Business Center

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Text version

SECTION E – OFFEROR’S REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS

EXHIBIT E-4

PAST PERFORMANCE QUESTIONNAIRE

You may recreate this form, but it must include all the information listed. If you fail to include all requested information or we are unable to contact your references based on the information you provide, you may not receive consideration for the work done. Include recent (not more than 3 years old) experience of the kind described in paragraph B1 of the specifications.

OFFEROR NAME:

DATE

Primary Type of Work Done:

Location of Work Done:
A/C Make/Model Used:

Contract #:

|_| None |_| Exclusive Use |_| Call When Needed

Use Dates: TO

CHECK ALL THAT APPLY

|_| 2020 |_|2019 |_|2018

Est. Annual Value of Work:

Estimated Annual Flight Hours:

Client Name/ Point of Contact:

Client Telephone #:
Client Email:

Primary Type of Work Done:

Location of Work Done:
A/C Make/Model Used:

Contract #:

|_| None |_| Exclusive Use |_| Call When Needed

Use Dates: TO

CHECK ALL THAT APPLY

|_| 2020 |_|2019 |_|2018

Est. Annual Value of Work:

Estimated Annual Flight Hours:

Client Name/ Point of Contact:

Client Telephone #:
Client Email:

Primary Type of Work Done:

Location of Work Done:
A/C Make/Model Used:

Contract #:

|_| None |_| Exclusive Use |_| Call When Needed

Use Dates: TO

CHECK ALL THAT APPLY

|_| 2020 |_|2019 |_|2018

Est. Annual Value of Work:

Estimated Annual Flight Hours:

Client Name/ Point of Contact:

Client Telephone #:
Client Email:

Primary Type of Work Done:

Location of Work Done:
A/C Make/Model Used:

Contract #:

|_| None |_| Exclusive Use |_| Call When Needed

Use Dates: TO

CHECK ALL THAT APPLY

|_| 2020 |_|2019 |_|2018

Est. Annual Value of Work:

Estimated Annual Flight Hours:

Client Name/ Point of Contact:

Client Telephone #:
Client Email:

Primary Type of Work Done:

Location of Work Done:
A/C Make/Model Used:

Contract #:

|_| None |_| Exclusive Use |_| Call When Needed

Use Dates: TO

CHECK ALL THAT APPLY

|_| 2020 |_|2019 |_|2018

Est. Annual Value of Work:

Estimated Annual Flight Hours:

Client Name/ Point of Contact:

Client Telephone #:
Client Email:

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