Attach_05_Experience_Questionnaire.pdf

Attachment 05: Experience Questionnaire

RFQ No.: 12034319Q0049 / Janitorial Service – Troy Ranger Station / Kootenai NF

USDA Forest Service

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 and Address)

3. BUSINESS

[ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] 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 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 & TELEPHONE # OF OWNER/PERSON TO

CONTACT FOR PROJECT INFORMATION

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

CONTRACT

NUMBER

DOLLAR AMT.

OF AWARD

NAME, ADDRESS, AND TELEPHONE NO. OF

BUSINESS/GOVERNMENT AGENCY INVOLVED

AWARDED

(UNITS)

PERCENT

COMPLETE

DATE CONTRACT

COMPLETED

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No

8b. Has work ever had a government or private contract recommended? [ ] Yes [ ] No

8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No

8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

Attachment 05: Experience Questionnaire

RFQ No.: 12034319Q0049 / Janitorial Service – Troy Ranger Station / Kootenai NF

(OVER)9. Organization and work that will be available for this project:

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

b. Are employees currently regularly on your payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:________________________________________________________________

10. List below the experience of the principal individuals of your business: (Who will directly be involved in this contract?) *NOTE:

Reference AGAR 452.237-74 Key Personnel (page 20) and list specific position of employee.

INDIVIDUAL’S NAME PRESENT POSITION YEARS OF

EXPERIENCE

MAGNITUDE AND TYPE OF WORK

11. REMARKS-SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR

ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT. (May use separate paper/format to submit).

*Please provide your Quality Control Plan (see paragraph 1.9) *Provide your process of operations (How will work be completed, Number of Employees, Administration, and any Sub- Contracting). If sub-contracting, provide name and contact information of sub-contract.

CERTIFICATION

I certify that all of the statements made by me are complete and correct t 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

b. SIGNATURE (Sign in ink) 13. DATE