J-3_Experience_Questionaire.pdf

RFQ No.: 12034319Q0009 / Attachment J-3-Experience / Page 1 of 2

USDA Forest Service (3/03)

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name & Address)

3. Business q Company Partnership q Corporation Individual q Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation

5. How many years experience in contracting have you or your business had as a (a) prime contractor ________ and/or

(b) sub-contractor ______

6. List below the projects your business has completed within the last three years:

Contract Amount

Type of Project

Date

Completed

Name, Address, and Telephone No. of Owner/Person to Contract for Project Information

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Contract Amount

Dollar Amt Of Award

Name, Address, and Telephone No. of Business/Government Agency Involved

Awarded (Units)

Percent Completed

Date Contract Complete d

8a. Have you ever failed to complete any work awarded to you? _____ Yes _____ No 8b. If “No”, explain:

a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________

b. Are employees regularly on your payroll? _____ Yes _____ No

c. Specify (only if applies) equipment available for this contract:____________________________________________

d. Estimate date or timeframe to complete this project:________________

e. Describe the safety measures and procedures employed by your firm. 1) How maximum safety is ensured for both employees and the public who may be on the work site during contract performance, 2) First Aid and evacuation plans in the event of an illness or injury.

Include Past Performance definitions so contractor know what they are being rated on.

RFQ No.: 12034319Q0009 / Attachment J-3-Experience / Page 2 of 2

i. Quality of services: Demonstrated ability to perform services in accordance with contract specifications.

ii. Customer Satisfaction: Satisfaction of end users with the contractor's completed services.

iii. Cost control:

iv. Business relations: Effective management, ability to manage projects involving subcontracts, working relationship with the contracting officer and technical representatives, reasonable/cooperative behavior, flexibility, effective contractor recommended solutions, businesslike concern for government's interests.

v. Timeliness of performance:

10. List below the experience of the principal individuals of your business:

Individual’s Name Present Position Years of Exp.

Magnitude and Type of Work

11. Remarks—Specify Box Numbers (Attach additional sheets if extra space is needed to fully answer any above questions, may use any format):

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 Forest Service with any information needed to verify my capability to perform this project.

12a.Certifying Official’s Name and Title

12b. Signature 13. Date