FORM_Past_Performance_Questionnaire.docx

Past Performance Questionnaire

READ CAREFULLY: The purpose of this form is for the offeror to list services performed during the past three (3) years that are similar to the work described in this solicitation. The number of projects listed shall not exceed five (5) and shall be numbered consecutively, beginning with the most recent project. Use this form to address your familiarity with the Scope of Work. Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their past performance may be considered by others to be less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record.

NAME OF CONTRACTOR/OFFEROR: PROJECT

NAME:

Project Location: Name of Owner: Address of Owner: Telephone Number: Project Value: Dates of Service:

DESCRIPTION OF THE PROJECT AND SCOPE OF OFFEROR’S WORK

PERFORMANCE REMARKS

Past

Performance Page of

DESCRIPTION OF THE PROJECT AND SCOPE OF OFFEROR’S WORK (continuation)

PERFORMANCE REMARKS (continuation)