Past_Performance_Questionnaire1.pdf
PDF 136 KB Posted
- Attached to
- MORR PURCHASE NEW DUMP TRUCK
- Solicitation number
- 140P4526Q0027
About this file
This is a Past Performance Questionnaire and References form for federal contract opportunity 140P4526Q0027 for a Morr Heavy Duty Dump Truck, issued by the National Park Service. The point of contact is Linda Richardson at linda_richardson@ios.doi.gov.
The questionnaire requires contractors to provide comprehensive past performance information including: years of experience in the type of work requested, years of experience as prime contractors and/or subcontractors, and three completed projects within the last five years with contract amounts, project types, completion dates, and reference contact information. Contractors must disclose whether they have ever failed to complete awarded work or required performance/payment bonds, with explanations if applicable. The form addresses contractor team composition by requiring contractors to indicate whether they plan to perform all work themselves or propose subcontractors, and if using subcontractors, to list each proposed subcontractor name, assigned key trade, and describe the work activities the prime contractor will perform. The references section requires detailed information on up to three relevant experiences, including contract type, contract number, total contract value, performing agency/firm, site contact person with telephone and email, work dates, and brief duty descriptions. All handwritten entries must be legible. The completed form must be returned via email to linda_richardson@nps.gov. A certification statement requires the submitting official to attest that all statements are complete and accurate, and that named references are authorized to provide verification of the contractor's capability to perform the project.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140P4526Q0027_Amd_0001.pdf | ||
| Sol_140P4526Q0027.pdf | ||
| Technical_Questionnaire1.docx | DOCX document |
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PAST PERFORMANCE QUESTIONNAIRE/REFERENCES
140P4526Q0027 MORR HEAVY DUTY DUMP TRUCK
0044047430
POINT OF CONTACT: LINDA RICHARDSON, linda_richardson@ios.doi.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
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:
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@ios.doi.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:
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