Attachment 7 -Experience Questionnaire.pdf
PDF 536 KB Posted
- Attached to
- Fenn Ranger Station roofing replacement
- Solicitation number
- 1240LU26Q0130
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire template used to evaluate contractor qualifications and past performance for contract opportunities.
The questionnaire collects comprehensive information about the contractor's organizational capacity and experience, including contractor name and contact details, business type (company, corporation, partnership, individual, or non-profit), and years of experience in the specific line of work contemplated by the solicitation. Respondents must document their experience as both prime contractors and subcontractors, and provide detailed information on similar projects completed within the past five years, including contract amounts, federal contract numbers if applicable, project types, completion dates, and contact persons for reference verification. The form requires disclosure of any failed work completion or performance bond invocations, with specific location and reason explanations if applicable. Section 8 addresses organizational capacity, requesting minimum and maximum employee availability, payroll status confirmation, and detailed equipment specifications available for contract performance. Section 9 requires listing principal individuals' names, cities of residence, present positions, years of experience, and the magnitude and type of work they have performed. The questionnaire includes a certification section requiring the signatory official to attest that all statements are complete and correct and that named references are authorized to provide verification information to the Forest Service regarding capability to perform the project. The form is submitted to the Forest Service PPS office located at 1019 N 5th Street, Custer, South Dakota 57730.
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, email Address, and phone number
2. Submitted to (Office Name & Address) 3. Business type 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 five years (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount & Federal Contract # if applicable
Type of Project Ongoing or
Date Completed
Person to Contact for Project Information include email or phone #
7a. Have you ever failed to complete any work awarded to you? _____ Yes _____ No 7b. Has work ever been completed by performance bond? _____ Yes _____ No 7c. If “Yes” to either item 7a or 7b specify location(s) and reason(s) why:
Forest Service PPS 1019 N 5th St Custer, SD 57730
8. 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 regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
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