Performance Relevancy.pdf

127A8620Q0015 Mineral Materials Appraisal

Exhibit B: PERFORMANCE RELEVANCY QUESTIONNAIRE

Provide the following information requested in this format for each of the projects/contracts being described. Projects may be ongoing and cannot have been completed any later than 3 years prior to the to this issue date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify. Use as much space as required. OFFEROR SHOULD PLACE

THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE.

INSTRUCTIONS: If extra space is needed use the reverse. Mark "X" in appropriate boxes.

CONTRACTOR NAME, ADDRESS & TELEPHONE

How many years do you or your firm have in the line of work contemplated by this solicitation ______? How many years experience in contracting have you or your business had as a (a) prime contractor _____ and/or (b) sub-contractor _____?

PART 1 - PAST / CURRENT PROJECTS

List below up to 5 projects your business has completed within the last 3 years similar in scope to the solicitation:

Contract Amount Type of Project Date Completed Name Address & Telephone No. of Person to Contact for Project Information.

List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract No. Dollar Amount of Project

Name, Address & Phone No. of Business Govt./Agency

Awarded (Units)

Completed

Date Contract Completed

Have you ever failed to complete any work awarded to you? Yes ( ) No ( ) Has work ever been completed by performance bond? Yes ( ) No ( ) If "Yes" to either item above specify location(s) and reason(s) why:

PART 2 – SPECIALIZED EXPERIENCE – For each of the projects listed above, address the following comments on a separate sheet:

a) Describe the specific elements of the work performed by your firm.

b) Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on Forest Service projects.

c) Address any technical areas about this project you consider uniquely relevant to this solicitation.

d) Point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number and facsimile number. Email address is also desired.

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.

Certifying Official's Printed Name and Title Signature (In Ink) Date