Past_Performance_Questionnaire.pdf
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- Attached to
- GATE-TROUBLESHOOT & REPAIR HVAC-BLDG 26
- Solicitation number
- 140P4526Q0010
About this file
This is a Past Performance Questionnaire and References form for RFQ SOL 140P4526Q00010, issued by the National Park Service for troubleshooting and repair of an HVAC system at Building 26 (GATE-SAHO). The point of contact is Linda Richardson at linda_richardson@nps.gov. The form is a template designed to be completed by all quoters seeking consideration for this contract opportunity.
Contractors must provide their business information, including UEI number, address, phone, and business type. The form requires disclosure of years of experience in the requested work type, contracting experience as prime contractor and/or subcontractor, and identification of three projects completed within the last five years similar in size and complexity to the solicited work, including contract amount, type, completion date, and detailed reference contact information (name, address, email, phone). Contractors must declare whether they have failed to complete any awarded work or required performance/payment bonds, and specify location and reason if applicable. The form addresses the proposed team structure, requiring confirmation of whether the contractor will perform all work or use subcontractors, with the mandatory requirement that the primary contractor perform a minimum of 51 percent of the labor. If subcontractors are proposed, contractors must identify them and their assigned key trade. The form includes a detailed References section requiring up to three experience examples with contract details, agency information, contact personnel, work period dates, and duty descriptions, with notation that handwritten responses must be legible. A certification section requires signature of an authorized official attesting to accuracy of all statements and authorization of references to provide verification information.
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Text version
PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
0044036671 GATE-SAHO Troubleshoot and Repair HVAC System at Bldg. 26
0044036671
RFQ SOL 140P4526Q00010
POINT OF CONTACT: LINDA RICHARDSON, linda_richardson@nps.gov
Past Performance Questionnaire
Contractor Name: UEI #
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:
CONTRACTOR’S PROPOSED TEAM:
Do you plan to perform all of the work? ___________________________ YES or NO answer
NOTE: The primary contractor shall perform a minimum of 51% of the labor.
Are you proposing to use a subcontractor? ___________________________ YES or NO answer
List any proposed subcontractor(s) and indicate what key trade may be assigned to perform:
Subcontractor Name Key Trade (electrical, etc)
If you are proposing to use a subcontractor, describe what work activities you plan to perform:
NOTE: The primary contractor shall perform a minimum of 51% of the labor.
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 #: ____________________________________________
POINT OF CONTACT: LINDA RICHARDSON, linda_richardson@nps.gov
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 .