B.08. Attach 6 - Past Perf Questionnaire (20-R-2005)(v2.0).pdf

FFOR OFFICAL USE ONLY

RFP W912L3-20-R-2005

ATTACHMENT 6 - PAST PERFORMANCE QUESTIONNAIRE

FOR OFFICAL USE ONLY

1.a. Project Name and Location: 1.b. Mark involvement for this project (Check the one that applies): (If other, describe in Block 26) Prime Contractor Sub-Contractor Joint Venture Other

2. Project owner’s complete address:

3a. Technical Point of Contact for project (Name, title, address, phone, fax, email):

4b. Contracting Point of Contact for the project (Name, title address, phone, fax, email):

4. Describe contract type (Service, etc), Nature and Scope of work:

4a. Current Status of Contract (Check the one that applies):

Work continuing, on schedule (must be greater than 50% complete) Work continuing, behind schedule Work completed, no further action pending Work completed, routine administrative action pending

Work completed, claims negotiation pending/underway Work completed, litigation pending/underway Terminated for convenience Terminated for default Other (explain in Block 26, Additional Comments)

5. Date work was begun (Day/Month/Year):

6. Date work was completed (Day/Month/Year):

Estimated Date of Completion: / / Actual Date of Completion*: / / *leave blank if project is ongoing

7. If actual completion date is later than initial completion date, explain why:

8. Initial contract price Amount for which Offeror was responsible:

$ _________________.00

9. Final invoiced amount (or amount invoiced to date) Amount for which Offeror was responsible:

$ _________________.00

10. If final invoiced amount greater than initial contract amount, explain why:

FFOR OFFICAL USE ONLY

RFP W912L3-20-R-2005

ATTACHMENT 6 - PAST PERFORMANCE QUESTIONNAIRE

FOR OFFICAL USE ONLY

11. Project Name and Location:

12. Explain any problem(s) encountered, and solution to resolve problem(s):

13. Were there any safety problems or accidents? Explain:

Provide, based on the job description, the names of the following personnel that worked on this project in following positions:

Job Description: First Name, Last Name:

Status During Project

(Check the one that applies):

14. 14a. 14b. In-House Subcontractor

15. 15a. 15b. In-House Subcontractor

16a. 16b. In-House Subcontractor

17. Additional Comments:

Please attach any Letters of Appreciation that apply ONLY to this project to this form.

15.

16. Site Supervisor