J1F - Past Performance Relevant Experience Questionaire.doc
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- Solicitation number
- 12445224R0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Past Performance and Relevant Experience Questionnaire. It requests information from contractors about their company, qualifications, and past projects to assess their relevant experience for a federal contract opportunity.
The key details include:
- Contractors must provide information on their business type, years of experience, and role as a prime contractor or subcontractor.
- Contractors must list 5 relevant projects completed within the last 5 years, including contract number, award amount, client information, contact details, and a detailed description of the work performed.
- Contractors must indicate if they have ever failed to complete any awarded work and provide an explanation.
- Contractors must list the experience of key personnel.
- The questionnaire is an attachment to a solicitation for a 5-year Multiple Award Task Order Contract (MATOC) for road maintenance, construction, and minor engineering services on National Forests in North Carolina and surrounding states. The MATOC will result in multiple contract awards divided into 4 Forest Zones.
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Text version
AG-4670-S-16-0117
ATTACHMENT 5
RELATIVE EXPERIENCE QUESTIONNAIRE
ATTACHMENT 5
PAST PERFORMANCE AND RELEVANT EXPERIENCE QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business
__Company __Co-Partner __Non-profit
__Corporation __Individual
3. How many years experience do you have in this line of work____Yrs
4. How many years experience as a prime contractor_____ subcontractor___
5. LIST OF RELEVANT PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST FIVE (5) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6. If "yes" to item 6a specify location(s) and reason(s) why
7. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
8. REMARKS (Additional sheets may be attached to the experience questionnaire)
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:
Name:
| Title: |
| Date: |
File details come from the government source that posted it. Updated .