12444021Q0001 Attach 5 Experience Questionnaire.docx
DOCX document 47 KB Posted
- Attached to
- Janitorial Services - Cherokee National Forest Ocoee RD Federal contract opportunity
- Solicitation number
- 12444021Q0001
- Issued by
- Department of Agriculture Forest Service
View the file
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| 12444021Q0001 Attach 1 GSA Cleaning and Disinfection Procedures.pdf | ||
| 12444021Q0001 SF 1449 Continuation Sheet.pdf | ||
| 12444021Q0001 Attach 2 WD Polk County.pdf | ||
| 12444021Q0001 SF 1449.pdf | ||
| 12444021Q0001 Attach 6 Performance Assessment Questionnaire.pdf | ||
| 12444021Q0001 Attach 4 Quality Assurance Surveillance Plan.pdf | ||
| 12444021Q0001 Attach 3 DM 4620-002.pdf |
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EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, remarks, if extra space is needed to answer any items 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 ___ Yrs
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. Housekeeping-Custodial Janitorial Services. List the services performed and quantities involved (Acreage/Each) and any other types of services 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): _______________________________________________
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): _______________________________________________
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): ______________________________________
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
6c 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, 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.
| Name/Address |
| Point of Contact |
| Telephone Number |
| Account Number |
8. REMARKS (Additional sheets may be attached to the experience questionnaire)
CERTIFCATION: 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 information needed to verify my capability to perform this project.
| Name: |
| Title: |
| Date: |
Attachment 5 - Solicitation 12444021Q0001 – Janitorial Services, Ocoee Ranger District
File details come from the government source that posted it. Updated .