C04e Experience Questionnaire 1240LT27Q0025.docx
DOCX document 40 KB Posted
- Attached to
- SNPLMA Kalamazoo Fence
- Solicitation number
- 1240LT27Q0025
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form issued by the USDA Forest Service for solicitation 1240LT27Q0025, the SNPLMA Kalamazoo Fence project on the Ely Ranger District. Prospective contractors must submit completed questionnaires to Terri Tucker via email at terri.tucker@usda.gov to demonstrate their qualifications and capacity to perform the work.
The solicitation requires construction of approximately 0.5 miles of barbed wire fence lines and four 12-foot wire gates near Kalamazoo Campground to exclude active grazing and address public safety hazards and complaints. The Experience Questionnaire requests detailed information regarding contractor experience, including years in the industry, prime and subcontractor history, and three years of similar fencing projects completed in rural mountainous terrain, specifically highlighting new barbed wire fence construction and wire gate installation. Contractors must also provide information on concurrent contractual commitments, employee availability (minimum and maximum), equipment resources, work progress rates, and experience of principal individuals managing the project. The form requires certification that all statements are complete and correct, with references authorized to verify the contractor's capability. This template does not establish pricing terms, response deadlines, award dates, or set-asides, which would be contained in the related solicitation documents.
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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 Email, SAM UEI.
2. Submitted to (Office Name and Address) Terri Tucker via email terri.tucker@usda.gov
| 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 that include fencing similar to those listed in the SOW that your business has completed within the last three years. Highlight the following factors in the Type of Project Section:
1. Construction of new barbed wire fence lines in rural mountainous terrain.
2. Construction of new wire gates in rural mountainous terrain.
| Box # |
| Contract Amount |
| Type of Project |
| Date Completed |
| Name, Address, and Telephone No. of Owner/Person to Contact for Project Information |
6. A
6. B
6. C
6. D
6. E
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation. Explain how you have kept in contact with the entity over the contract. What were the communication methods? How did you ensure that the product is what was wanted. How was the project inspected. How have you handled disputes if any?
| Contract Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded (Units) |
| Percent Completed |
| Date Contract 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 (This box will extend as information is added to accommodate extra space.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT. (Examples for elaboration of projects listed in Box 6).
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 |
File details come from the government source that posted it. Updated .