Attachment001-ExperienceQuestionaire.pdf
PDF 26 KB Posted
- Attached to
- 2019 Contracting West Road Maintenance BPA Federal contract opportunity
- Solicitation number
- 1204T019Q0023
About this file
This document contains an Experience Questionnaire template and information about a related federal contract opportunity for road maintenance services. The Experience Questionnaire is a template used by the USDA Forest Service to collect information about a contractor's qualifications and past performance. It requests details such as the contractor's name and address, years of experience, recent project examples, current commitments, personnel, and equipment available.
The related federal contract opportunity is a total small business set-aside to provide road maintenance services for five National Forests in the Pacific Northwest Region. Services include grading, surfacing, hauling materials, rolling dips, drainage cleaning, and hourly equipment rentals. The agency will award multiple firm-fixed-price blanket purchase agreements to contractors submitting offers for items in specific districts and forests. Work may be required simultaneously across districts. The solicitation will be available on May 3rd and awards are estimated to take effect on July 1, 2019. Prospective awardees must be registered in the System for Award Management to be eligible for award.
Attachment 1 - Experience Questionnaire
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 1204T019Q0023-Amendment2.pdf | ||
| 1204T019Q0023-Amendment1.pdf | ||
| Attachment002-ServiceWageDetermination.pdf | ||
| Attachment005b-UMP-RoadRules.pdf | ||
| Attachment006a-RRS-Items8-10-SOW.pdf | ||
| Attachment005a-UMP-Items5-7-SOW_SPECS.pdf | ||
| 1204T019Q023-Solicitation_GeneralInstructionsClausesProvisions.pdf | ||
| Attachment004-WIL-Items2-4-SOW_SPECS.pdf | ||
| Attachment006d-RRS-Item10-SPECS.pdf | ||
| Attachment003-SIU-Item1-SOW_SPECS.pdf | ||
| Attachment006b-RRS-Item8-SPECS.pdf | ||
| 1204T019Q023-ReturnPacket.pdf | ||
| Attachment006c-RRS-Item9-SPECS.pdf | ||
| Attachment007-FW-Items11-13-SOW_SPECS.pdf |
Show all 14
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 11)
Instructions: See Box 11, remarks, if extra space is needed to answer any of them 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 in contracting have you or your business had as a (a) prime contractor_____ and/or (b) subcontractor_____
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
CONTACT FOR PROJECT INFORMATION
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
AMOUNT
DOLLAR AMT.
OF AWARD
NAME, ADDRESS AND TELEPONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
AWARDED
(UNITS)
PERCENT
COMPLETED
DATE
COMPLETED
8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No
* If “Yes” to either 8a or 8b specify location(s) and reason(s) why:
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 employee regularly on you payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:_________________________________________________________________________
d. Estimated rate of progress below ( such as 20 acres/man/day):
(1) Minimum progress rate:___________ and (2) Maximum progress rate___________
10. List below the experience of the principle individuals of your business:
11. REMARKS - SPECIFY BOX NUMBERS
(Attach sheets if extra space is needed to fully answer any above questions:)
CERTIFICATION
12a. CERTIFYING OFFICAL’S NAME AND TITLE
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.
b. SIGNATURE (Sign in ink) 13. DATE
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