Recent Relevant Experience and Past Performance Questionnaire.doc

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Attached to
BLACKTAIL CLASS III CULTURAL RESOURCES INVENTORY Federal contract opportunity
Solicitation number
140L1021Q0005
Issued by
Department of the Interior Bureau of Land Management Montana-Dakotas

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Recent Similar Experience/Past Performance Questionnaire

Contractor Name: ____________________________________________________________________________ How many years of similar experience have you or your business had regarding the type of work required by this solicitation? ____________ Recent Similar Experience: List the jobs your business has completed that are both recent (within the last 5 years) and similar in both magnitude and complexity to the requirements of this solicitation.

Include: description the work performed, please use a separate page if necessary, date the job was completed Past Performance: List a minimum three references with contact information (name, phone number, email). Contact information should be for recent similar experience.

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 Bureau of Land Management with any information needed to verify my capability to perform this project.

Certifying Official Name and Title:

Signature:

Date:

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