Past Performance Data Sheet.docx

PAST PERFORMANCE DATA SHEET

1. Contractor Name & Address, POC Name, Telephone No., & Email Email: @ .

2. How many years experience do you have in this line of work? Years

3. How many years experience as a prime contractor? Years – As a subcontractor? Years

4. Past Performance: Provide information requested on relevant projects your business has completed in the last 3 years

PROJECT 1

Contract Number:

Project Name:

Total Contract Value:

Completion Date:

Contract Type (fixed price, ect):

Prime or Sub:

Agency/Company Work was Done for:

Contracting Officer (Name & Email):

COR/Project Mgr. (Name & Email):

Project Description:

PROJECT 2

Contract Number:

Project Name:

Total Contract Value:

Completion Date:

Contract Type (fixed price, ect):

Prime or Sub:

Agency/Company Work was Done for:

Contracting Officer (Name & Email):

COR/Project Mgr. (Name & Email):

Project Description:

PROJECT 3

Contract Number:

Project Name:

Total Contract Value:

Completion Date:

Contract Type (fixed price, ect):

Prime or Sub:

Agency/Company Work was Done for:

Contracting Officer (Name & Email):

COR/Project Mgr. (Name & Email):

Project Description:

6a. Have you ever failed to complete any work awarded to you? |_| Yes |_| No 6b. Has work ever been completed by performance bond? |_| Yes |_| No 6c. If ‘Yes’ was checked to either item 7a or 7b, specify location(s) and reason(s) why:

11. Remarks (if extra space is needed to answer any item above):

12. 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 capabilities to perform this project.

Signature: ______________________________ Date: ______________ Name:

Title: