Attachment 6-EXPERIENCE QUESTIONNAIRE.pdf
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- Solicitation number
- 12435H20Q0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This document includes an experience questionnaire attachment and details for a federal contract opportunity to provide janitorial services. The experience questionnaire requests information on the contractor's experience, past projects including location and description of services, failures to complete work, and performance bond claims. The federal contract opportunity is a small business set-aside to provide janitorial services for recreational sites on the Blue Ridge Ranger District. The period of performance is expected to begin on or after March 20, 2020 for the location of Blue Ridge Ranger District Recreational Sites. Quotes must be submitted electronically by March 6, 2020. The associated NAICS code is 561720 and small business size standard is $19.5 million. The Department of Agriculture Forest Service is the issuing agency.
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Attachment 6 - Page 1 of 2
ATTACHMENT 6 –EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address & Telephone No. 2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual
3. How many years experience do you have in this line of work____Years
4. How many years experience as a prime contractor_____ subcontractor___
5. LIST OF PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST 3 YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e.
asphalt, paving, subgrade repair.) List the services performed and quantities involved (miles, linear feet) and any other types of resurfacing, subgrade repair or other similar work accomplished).
Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Project & Location ______________________________________________________________________________________________
Contract Number:_______________________________ Award Amount: ________________________________________________
Period of Performance and/or completion date: ________________________________________________________________________
Client/Company’s Name/Address: __________________________________________________________________________________
Contact Name, email and Telephone number: ________________________________________________________________________
Description of Services (refer to note in No. 5 type of asphalt, paving, resurfacing, subgrade repair etc.)
Project & Location ______________________________________________________________________________________________
Contract Number:_______________________________ Award Amount: ________________________________________________
Period of Performance and/or completion date: ________________________________________________________________________
Client/Company’s Name/Address: __________________________________________________________________________________
Description of Services (refer to note in No. 5 type of asphalt, paving, resurfacing, subgrade repair etc.)
Project & Location ______________________________________________________________________________________________
Contract Number:_______________________________ Award Amount: ________________________________________________
Period of Performance and/or completion date: ________________________________________________________________________
Client/Company’s Name/Address: __________________________________________________________________________________
Contact Name, email and Telephone number: ________________________________________________________________________
Description of Services (refer to note in No. 5 type of asphalt, paving, resurfacing, subgrade repair etc.)
Attachment 6- Page 2 of 2
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6b. Has work ever been completed by performance bond? __yes __ no
6. If "yes" to either item 6a or 6b specify location(s) and reason(s) why
7. Information required to complete a responsibility determination, if necessary, of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References
Company Name/Address Point of Contact Telephone number Materials/Services Provided
b. Banking Information.
Company Name/Address Point of Contact Telephone number Account No.
8. REMARKS (Additional sheets may be attached to the experience questionnaire)
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:
Name: Title: Date:
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:
Name: Title: Date:
ATTACHMENT 4 –Experience Questionnaire
File details come from the government source that posted it. Updated .