P2-PastPerformanceQuestionnaire.pdf

Past Performance Questionnaire (Please complete this or similar and submit with quote)

Contractor Name: ____________________________________________________________________________

Phone Number: ______________________ Email: _________________________________________________

Type of Business:

_____Company ____Co-partnership ______Corporation _____ Individual ____Non-Profit Organization

How many years of relevant experience have you or your business had regarding the type of work required by this solicitation? ____________

How many years experience in contracting have you or your business had as a Prime Contractor? ____________ …. as a Sub-contractor? ____________

List the projects your business has completed within the last three years that are relevant in both magnitude and complexity to the requirements of this solicitation. Include: [] the contract amount [] a brief description of the work performed [] date completed, and [] the name of the contact with telephone number. Attach a separate page if necessary. Only projects relevant to this solicitation and its requirements will be considered.

List contract commitments that will run concurrently with the work requested in this solicitation, include name, address, telephone number, start and finish date.

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, specify location and reason on a separate page.

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 Bureau of Land Management with any information needed to verify my capability to perform this project.

Certifying Official Name and Title:

Signature (Sign in Ink):

Date: