12444124Q0105 Attachment 3 Relevant Experience Questionnaire.doc
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- Solicitation number
- 12444124Q0105
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Relevant Experience (Past Performance) Questionnaire for a federal contract opportunity. The questionnaire is part of solicitation 12444124Q0105 for the Nantahala National Forest Beech Creek Genetic Resource Management Areas (GRMA) Seed Orchard Collection of Shortleaf Pinecones for Seed Extraction in North Carolina.
The questionnaire requests information about the contractor's business, years of relevant experience, prior projects completed within the last 3 years, and any issues with failing to complete work. It also requires information about the principal individuals and their experience, as well as credit and banking references to support a responsibility determination. The contract opportunity is seeking services to provide all equipment, operators, labor, transportation, and supplies necessary to hand-pick fresh, ripe shortleaf pinecones within a critical 30-45 day timeframe, with the work to be awarded on a best value basis considering technical capability, relative experience, and price.
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Other files
| File | Type | Posted |
|---|---|---|
| 12444124Q0105 Attachment 4 Technical Capability Statement.docx | DOCX document | |
| 12444124Q0105 Attachment 5 Represenations and Certifications.docx | DOCX document | |
| 12444124Q0105 Attachment 1 FY24 Statement of Work Shortleaf Pinecones Seed Extraction.docx | DOCX document | |
| 12444124Q0105 1449.docx | DOCX document | |
| 12444124Q0105 Attachment 2 WD NC 2015-4417 Rev 25 240722.pdf |
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Text version
AG-4670-S-16-0117
ATTACHMENT 5
RELATIVE EXPERIENCE QUESTIONNAIRE
1244412Q0105
ATTACHMENT 3
RELEVANT EXPERIENCE (PAST PERFORMANCE) QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email
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 RELEVANT PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
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. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
8. Information required to complete a responsibility determination 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. (NOTE: Only POC information is required. Please do NOT provide your account information.)
| Company Name/Address |
| Point of Contact |
| Telephone number |
9. 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: |
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