C04g Attachment 7 Experience Questionnaire.pdf
PDF 173 KB Posted
- Attached to
- Janitorial services- Pagsoa Ranger District
- Solicitation number
- 1240LP27Q0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form (FS-6300-27) used to evaluate contractor qualifications and capability to perform contract work.
The form requires contractors to provide comprehensive information about their business, experience, and resources. Contractors must supply basic company details including name, address, telephone number, UEI (formerly DUNS number), email address, and business structure (company, corporation, co-partnership, individual, or non-profit organization). The questionnaire requests the number of years the contractor has worked in the relevant line of work and experience as both prime and sub-contractors. Contractors must list projects completed within the last three years with contract amounts, project descriptions, completion dates, and owner contact information for reference verification. Additionally, contractors must disclose all concurrent contractual commitments, including contract numbers, dollar amounts, percent completion status, and expected completion dates. The form requires disclosure of any instances where work was not completed or required performance bond completion, with explanations of locations and reasons.
The questionnaire also assesses organizational capacity, requiring minimum and maximum employee counts, confirmation of regular payroll status, and estimated progress rates. Contractors must provide detailed information about principal individuals' experience, including names, present positions, years of experience, and magnitude and type of work. Section 11 requires a comprehensive listing of all equipment and vehicles to be used, including detailed descriptions and maintenance plans. Section 12 requires a detailed contractor self-inspection and quality control plan, safety plan, information on bio-based products and materials, and a proposed work schedule. The form concludes with a certification section requiring the certifying official's name, title, signature in ink, and date, with the certifying party attesting that all statements are complete and correct.
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Text version
Experience Questionnaire
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
UEI (Formerly DUNS #) _____________________ E-Mail #_____________________
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) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
CONTRACT
AMOUNT TYPE OF PROJECT/DESCRIPTION
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:
CONTRACT
NUMBER
DOLLAR AMT.
OF AWARD
NAME, ADDRESS, AND TELEPHONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
AWARDED
(Units)
PERCENT
COMPLETED
DATE CONTRACT
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 8c. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:
Previous edition is obsolete (OVER) FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
a. (1) Minimum number of employees: _____ and Maximum number of employees: _____
b. Are employees regularly on your payroll: Yes No
c. 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:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
11. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.
12. Contractor Inspection/Quality Control, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products & materials to be used on this project, a brief safety plan, and your planned schedule of work.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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 name 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
File details come from the government source that posted it. Updated .