Past_Performance_Questionnaire_-_Survey_Wall.pdf
PDF 137 KB Posted
- Attached to
- EDIS - CONDUCT SURVEY OF BASEMENT WALL
- Solicitation number
- 140P4526Q0007
About this file
This is a Past Performance Questionnaire and References form for RFQ 140P4526Q0007, issued by the National Park Service (NPS) for conducting a survey of basement wall at the Edison Historic Site (EDIS). The point of contact is Roselyn Sessoms at roselyn_sessoms@nps.gov.
The form requires all quoters to provide comprehensive past performance information to receive consideration. Contractors must complete sections requesting basic company information (name, DUNS number, address, phone/fax, and business type), years of experience in the requested work type, and years of experience as a prime contractor and/or subcontractor. Contractors must list three projects completed within the last five years that are similar in size and complexity to the proposed work, including contract amounts, project types, completion dates, and detailed reference contact information (name, telephone, email address). The form also requires responses to whether the contractor has failed to complete awarded work and whether any work has been completed under performance or payment bonds, with explanations if applicable. Contractors must provide three separate experience entries with detailed descriptions of duties performed. All statements must be certified as complete and correct by an authorized official with an ink signature. The completed form must be returned via email to roselyn_sessoms@nps.gov. If handwritten, all information must be legible.
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Text version
PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
RFQ:140P4526Q0007 EDIS – CONDUCT SURVEY OF BASEMENT WALL
POINT OF CONTACT: ROSELYN SESSOMS, roselyn_sessoms@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
Brief description of duties
Experience No. 3
Brief description of duties:
Return form to:
Email: roselyn_sessoms@nps.gov
File details come from the government source that posted it. Updated .