1202SC25Q2900 Attachment 3 Experience Questionnaire.docx
DOCX document 46 KB Posted
- Solicitation number
- 1202SC25Q2900
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is an Experience Questionnaire for Solicitation 1202SC25Q2900 for Mental Health Professionals, issued by the USDA Forest Service Incident Procurement Operations (IPO). The form requires potential contractors to provide detailed information about their business, including years of experience, project history, and references. Key sections include listing completed projects within the last 3 years, providing contract details, client information, and service descriptions, as well as disclosing any past performance issues.
The associated solicitation is a Blanket Purchase Agreement (BPA) for Critical Incident Stress Management (CISM) clinician services, set aside 100% for small businesses. The procurement uses NAICS code 621330 with a $9M small business size standard. Vendors must be registered in the System for Award Management (SAM). Key dates include a question deadline of March 26, 2025, and quote submission deadline of April 1, 2025, both at 3:00 PM Mountain Standard Time. Quotes must be emailed to Lindsey Christian, and the resulting agreement will be a Firm-Fixed-Price BPA with a base period and four ordering periods.
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Attachment 3 Solicitation 1202SC25Q2900 Mental Health Professionals, CISM IPO, Logistics Contracting Branch
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, remarks, if extra space is needed to answer any items below. Additional sheets may be attached.
| 1. Contractors Name, Address & Telephone No. |
| 2. Type of Business |
__ Company __ Co-Partner __ Non-profit
__ Corporation __ Individual
3. How many years’ experience do you have in this line of work ___ Yrs
4. How many years’ experience as a prime contractor ___ subcontractor ___
5. LIST OF PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST 3 YEARS
Note: The description of work performed should be in sufficient detail for the Government to determine what the work included (i.e. Mental Health Professionals, CISM). List the services performed and quantities involved (Acreage/Each) and any other types of services or other similar work accomplished).
Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Project Location: ________________________________________________________________________
Contract Number: _________________________ Award Amount: $________________
Period of Performance and/or Completion Date: __________________________________
Client/Company’s Name/Address: __________________________________________________________
Contact Name, Email and Telephone Number: ________________________________________________
Description of Services (Refer to Note in No. 5): _______________________________________________
Project Location: _________________________________________________________________________
Contract Number: _________________________ Award Amount: $___________________
Period of Performance and/or Completion Date: _____________________________________________
Client/Company’s Name/Address: __________________________________________________________
Contact Name, Email and Telephone Number: _______________________________________
Description of Services (Refer to Note in No. 5): _______________________________________________
Project Location: ________________________________________________________________
Contract Number: _________________________ Award Amount: $___________________
Period of Performance and/or Completion Date: ______________________________________
Client/Company’s Name/Address: _________________________________________________
Contact Name, Email and Telephone Number: _______________________________________
Description of Services (Refer to Note in No. 5): ______________________________________
6a. Have you ever failed to complete any work awarded to you? __ Yes __ No
6b. Has work ever been completed by performance bond? __ Yes __ No
6c. If “Yes” to either item 6a or 6b specify location(s) and reason(s) why.
7. Information required to complete a responsibility determination. If necessary, of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award. Moreover, contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References.
| Company Name/Address |
| Point of Contact |
| Telephone Number |
| Materials/Services Provided |
b. Banking Information.
| Name/Address |
| Point of Contact |
| Telephone Number |
| Account Number |
8. REMARKS (Additional sheets may be attached to the experience questionnaire)
CERTIFCATION: 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 information needed to verify my capability to perform this project.
| Name: |
| Title: |
| Date: |
File details come from the government source that posted it. Updated .