Portable Toilet Rental and Services

PAST PERFORMANCE RESPONSE QUESTIONNAIRE

Source Selection Sensitive (when filled-out) IAW FAR 2.101 and FAR 3.104

Instructions: Fill-in offeror name in footer. For each factor below, in the first table provide a detailed description
of specific tasks performed for that factor. Use the reference table to provide a minimum of one (1) and up to five
(5) references per factor to support the experience claimed in the first table. Limited to a twenty five (25) page
submission.

Factor 1. Past Performance. Three (3) years of experience within the (5) year period immediately preceding
release of this Request for Quote (RFQ), providing Portable Toilet and Related Services, as more specifically
described below in Factor 1. The experience called out in Factor 1 is for work which is the same or substantially
similar to the work activities and tasks described in the respective factor. Provide reference and contact information
to support the experience claimed by offeror. If offeror intends or proposes to use an entity other than offeror to
fulfill a requirement or a portion thereof (e.g. a sub-contractor or other teaming partner), please provide ALL the
requested information for that entity as well.

To Be Considered Acceptable for Factor 1: The offeror’s responses evidence the offeror (or the entity other than
offeror which offeror intends or proposes to use to fulfill a requirement or portion thereof) has three (3) years of
experience within the five (5) year period immediately preceding the release of this RFQ, performing the same or
substantially similar work to the work activities and tasks described in each of the factors and the referenced
statement of work (SOW) paragraph(s). References provided must support the experience claimed by offeror.

Factor 1, Portable Toilet Services. At least three (3) years of experience within the five (5) year period
immediately preceding release of this RFQ. Use the narrative block to provide a detailed description of EACH task
performed related to providing Portable Toilet Rental and Related Services identified in the table immediately
below (Reference PWS paragraph 1.3.2.3).

3 Years of Experience
Portable Toilet Rental and Servicing
Within the Last 5 Years
- Ability to meet unit ordering and scheduling timelines. Ability to meet delivery,
placement & Anchoring/Securing (Soft Areas, Asphalt, & Concrete) of Units.
Reference PWS Para. 1.(a)(1) – Para 1(a)(6). Yes No
-If utilizing Subcontractor, do they have the ability to meet unit ordering and
scheduling timelines.

Narrative (please type in form and use as much detail as necessary to respond):

Offeror:________________________
RFQ FA461022Q0012
Attachment 4
Page 1 of 2
 Portable Toilet Rental and Services
PAST PERFORMANCE RESPONSE QUESTIONNAIRE
Source Selection Sensitive (when filled-out) IAW FAR 2.101 and FAR 3.104

Past Performance Reference #1, Factor 1 (required)

Performed as Prime
Contract Type Performed By
Period of (P) or Sub (S)?
Contract # Total Value (Firm Fixed Price (provide name of
Performance Check as
[FFP] or Cost) company)
appropriate
P S
POC Name:
Phone #:
Email:

Past Performance Reference #X, Factor 1

Repeat this block as necessary up to maximum of five (5)
Performed as Prime
Contract Type Performed By
Period of (P) or Sub (S)?
Contract # Total Value (Firm Fixed Price (provide name of
Performance Check as
[FFP] or Cost) company)
appropriate
P S
POC Name:
Phone #:
Email:

Offeror:________________________
RFQ FA461022Q0012
Attachment 4
Page 2 of 2