Past Performance Experience Questionnaire.pdf
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- Solicitation number
- 127EAT21Q0004
About this file
This document contains a solicitation from the Department of Agriculture Forest Service for vault toilet and septic tank pumping services in the Angeles National Forest. The contractor shall pump and dispose of all waste from toilets in accordance with specifications and regulations. Quotes are due no later than December 31, 2020 and shall include a schedule of items, technical response demonstrating ability to meet requirements, past performance questionnaire, and pricing. The non-price factors of technical capability and past performance are significantly more important than price. Award may be made to a single quoter or combination of quoters to provide services across multiple areas.
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Text version
EXPERIENCE QUESTIONNAIRE
1. CONTRACTOR NAME, ADDRESS AMD PHONE#
2. SUBMITTED TO (Office Name & Address)
3. BUSINESS:
__Company ___Co-partnership __Corporation ___Individual __Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAVE YOU OR YOUR FIRM HAD AS A:
PRIME CONTRACTOR_________________ AND/OR SUB-CONTRACTOR_____________
6. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:
CONTRACT
AMOUNT
TYPE OF PROJECT
DATE
COMPLETED
NAME,ADDRESS,&PHONE OF OWNER /PERSON TO
CONTACT FOR PROJECT INFORMATION
7. LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE
WORK CONTEMPLATED BY THIS PROJECT:
CONTRACT
NUMBER
AMOUNT
OF
AWARD
NAME, ADDRESS & PHONE # OF BUSINESS/GOVERNMENT
AGENCY INVOLVED
AWARDED
(UNITS)
PERCENT
COMPLETED
COMPLETED
8a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? ______YES _____NO 8b. HAS WORK EVER BEEN COMPLEED BY PERFORMANCE BOND? ______YES _____NO 8c. IF “YES” TO EITHER ITEMS SPECIFY LOCATION(S) AND REASON(S)WHY:
EXPERIENCE QUESTIONNAIRE PAGE 2
9. ORGANIZATION AND WORKERS THAT WILL BE AVAILABLE FOR THIS PROJECT:
a. MINIMUM NUMBER OF EMPLOYEES:___________ AND MAXIMUM NUMBER OF EMPLOYEES:__________
b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL? ______YES _______ NO
c. SPECIFY EQUIPMENT AVAILABLE FOR THIS
CONTRCT:_______________________________________________
d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 2.0 ACRES/MAN/DAY):
MINIMUM PROGRESS RATE:______________________ AND MAXIMUM PROGRESS RATE:_________________
10. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
11. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):
12a. CERTIFYING OFFICIAL’S NAME AND
TITLE
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.
12b. SIGNATURE (Sign in Black Ink)
13.
AMOUNT
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