C04 Attachment 5 Exp Questionnaire.pdf
PDF 37 KB Posted
- Solicitation number
- 1240LP26Q0130
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor capability and qualifications for solicited work.
The questionnaire requires contractors to provide comprehensive background information including: company name, address, and telephone number; business structure (company, corporation, co-partnership, individual, or non-profit); years of experience in the relevant line of work; years of experience as prime and sub-contractors; and detailed project history from the past three years with contract amounts, project types, completion dates, and owner contact information. Contractors must also list all concurrent contractual commitments with contract numbers, award amounts, business/government agency names, units awarded, percent completion status, and contract completion dates. The form includes yes/no questions regarding work completion failures, performance bond completions, and on-site project inspections, with space for explanation if applicable. Section 9 requests information on workforce availability (minimum and maximum employee counts), payroll status, equipment specifications, and estimated rates of progress. Section 10 requires documentation of principal individuals' experience who will be directly involved, including their positions, years of experience, and work magnitude and type. The form includes a remarks section for additional information and concludes with a certification statement that the contractor must sign and date, attesting to the accuracy and completeness of all provided information and authorizing references to verify capability.
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Other files
| File | Type | Posted |
|---|---|---|
| A04 Attachment 1 Updated SOW Garage Doors.pdf | ||
| C04 Attachment 6 15-5415 Wage Determination Boulder County.txt | TXT text file | |
| C04 Attachment 3 Garage Door Pictures.pdf | ||
| C 04 1240LP26Q0130.pdf | ||
| C04 Attachment 4 Certificate of Conformance.docx | DOCX document | |
| C04 Attachment 2 Schedule of Items.xlsx | XLSX spreadsheet |
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Text version
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, 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:
Number
Dollar Amt.
of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date
Complete
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 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:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:______________________________________________________
d. Estimate rate of progress below (such as 2.0 acres/man/day):
(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________
10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)
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.
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
b. SIGNATURE (Sign in ink) 13. DATE
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