0016 12445123R0034 Construction Experience Questionaire Fillable.pdf
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- Solicitation number
- 12445123R0034
- Issued by
-
Department of Agriculture Forest Service
About this file
This solicitation requests proposals for a trail improvement project located on the Pisgah National Forest in North Carolina. Work will be broken into phases and includes constructing boardwalks, stairs, retaining walls, turnarounds, and viewing platforms to improve user safety and reduce erosion. Phase 1C focuses on building a series of boardwalks and stairs from an existing stair tower, along with clearing, hazard tree removal, and resurfacing 5,300 linear feet of trail. Proposals are due by July 18, 2023 with award being made as a firm-fixed price contract to the best value offer. The estimated value is between $500,000 to $1,000,000. The soliciting agency is the USDA Forest Service for NAICS code 237310.
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Text version
Source Selection Information ‐ See FAR 2.101, 3.104 and 15.101‐2 For Official Use Only
APPENDIX D: Construction Experience Questionnaire
Catawba Falls Trail Improvements Solicitation 12445123R0034
Construction Experience Questionnaire (to be completed by contractor)
Instructions: Do not alter the form, except for expanding the individual response blocks. The total length for each project data sheet shall not exceed three (3) double-sided 8.5” x 11”pages and shall be Times New Roman 11 font (minimum). Use Box 10 Remarks if extra space is needed to answer any item below.
Answer all items.
1. Contractor’s Name, Address & Telephone #. 2. Type of Business
___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization
3. How many years’ experience do you have in this line of work? ______ years
4. How many years’ experience as a prime contractor? ______ years
And as a subcontractor? ______ years
5. List the projects/contracts your business has completed in the last five (5) years.
CONTRACT
AMOUNT
TYPE OF CONTRACT DATE
COMPLETED
Contact Name, Address and Tele. #
Solicitation No: 12445123R0034
Project Name: Catawba Falls Trail Phase 1 C
FAC 2023-04 dated June 2, 2023
6. List all of your firms’ current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
Contact Name, Address & Tele. #
Percent Completed
Date Contract Completed
7a. Have you ever failed to complete any work awarded to you? ___yes ___no 7b. Has work ever been completed by performance bond? ___yes ___no
7c. If “yes” to either item 7a or 7b above, specify reason(s) and location(s) why.
8. Organization structure that will be available for this project:
a. Minimum No. of employees: _____ and Maximum No. of employees: _____
b. Are employees regularly on your payroll? ___yes ___no
c. Specify equipment available for this contract:
d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc.):
Minimum progress rate: ____________ Maximum progress rate:____________
9. List the experience of the principal individuals of your business
NAME PRESENT POSITION YRS
EXP.
TYPE OF WORK
Solicitation No: 12445123R0034
10. REMARKS
unique Sam#_______________ Tax ID#______________
CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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.
Signature Print or Typed Name Title Date
Solicitation No: 12445123R0034
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| 7c If yes to either item 7a or 7b above specify reasons and locations why 1: |
| 7c If yes to either item 7a or 7b above specify reasons and locations why 2: |
| 7c If yes to either item 7a or 7b above specify reasons and locations why 3: |
| 7c If yes to either item 7a or 7b above specify reasons and locations why 4: |
| a Minimum No of employees: |
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| Specify equipment available for this contract 1: |
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| CERTIFICATION I certify that all of the statements made by me are complete and correct to be best of: |
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