Past_Performance_Experience_Questionnaire.doc

Relevant Experience/Past Performance Questionnaire

Solicitation Number:__________________________________________________________________________

Contractor Name: ____________________________________________________________________________ Phone Number: ______________________ Email: _________________________________________________ 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? ____________ Relevant Experience: List the projects your business has completed 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.

Past Performance: List a minimum three references with contact information (name, phone number, email) 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: