Past_Performance_Questionnaire.pdf

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Attached to
EDIS CONSERVE TOP PRIORITY RUGS Federal contract opportunity
Solicitation number
140P4524Q0047
Issued by
Department of the Interior National Park Service

About this file

This document is a Past Performance Questionnaire related to a federal contract opportunity for the EDIS CONSERVE TOP PRIORITY HISTORIC RUGS solicitation (140P4524Q0047) issued by the Department of the Interior National Park Service.

The questionnaire requests information about the contractor's past performance, including the number of years of experience in the types of work requested, the number of years as a prime contractor or subcontractor, and details on three relevant projects completed within the last five years. The contractor must provide references, including a point of contact, for each past project. The questionnaire also asks if the contractor has ever failed to complete any awarded work or had work completed by a performance/payment bond. The completed questionnaire must be submitted to the Point of Contact, Linda Richardson, at linda_richardson@nps.gov.

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Text version

PAST PERFORMANCE QUESTIONNAIRE/REFERENCES

140P4524Q0047 EDIS CONSERVE TOP PRIORITY HISTORIC RUGS

140P4524Q0047 POINT OF CONTACT: LINDA RICHARDSON, linda_richardson@nps.gov

Past Performance Questionnaire

Contractor Name: Duns #

Address: City: State: Zip:

Phone Number: Fax Number:

Type of Business:

_____Company ____Co-partnership ______Corp._____ Individual ____Non-Profit Org.

How many years do you or your firm has in the types of work requested by this solicitation?

_________________year(s).

How many years experience in contracting have you or your business had as a Prime Contractor? _________year(s) and/or Sub-contractor: _______(years)

List below the three (3) projects your business has completed within the last five (5) years of the proposed service requested by this solicitation, include the contract amount, the type of project, date completed and your reference contact name, address, email address and telephone number: (SEE ATTACHED SHEET)

Have you ever failed to complete any work awarded to you? ______Yes _____No

Has work ever been completed by performance/payment bond? ______Yes ______No

If “Yes” to either item, specify location and reason:

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 National Park Service with any information needed to verify my capability to perform this project.

Certifying Official Name and Title:

Signature (Sign in Ink):

Date:

PAST EXPERIENCE & REFERENCES

REFERENCES:

This form must be completed by all quoters in order to receive consideration. If additional space is needed, this form may be duplicated as necessary. List any current or past experience which is pertinent to this position. Past performance and experience may be a combination of up to two contracts similar in size and complexity to those stated in the Technical Provisions and work experience in similar positions, performing duties similar in nature and complexity to the required services. Include (separately) details of any training which would enable you to better perform the work outlined in the specifications. Reference information should include a point-of-contact's name, telephone number and e-mail address. (IF

HANDWRITTEN, MUST BE LEGIBLE)

Experience No. 1

Contract/Work type: ____________________________________________

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Month/Year work began: Month/Year work ended: ________________________________________

Brief description of duties:

Experience No. 2

Contract/Work type: ____________________________________________

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Brief description of duties

Experience No. 3

Contract/Work type: ____________________________________________

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Brief description of duties:

Return form to:

Email: linda_richardson@nps.gov mailto:linda_richardson@nps.gov

Type of Business:

File details come from the government source that posted it. Updated .