C04b Experience Questionnaire.docx
DOCX document 26 KB Posted
- Attached to
- Forest Products Lab Campus Tree Care Federal contract opportunity
- Solicitation number
- 12444526Q0052
- Issued by
- Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form required by the USDA Forest Service for contractor evaluation in response to the Forest Products Lab Campus Tree Care solicitation (12444526Q0052).
The questionnaire requests comprehensive information about the contractor's qualifications and capacity to perform tree care services on the FPL campus. Contractors must provide company information, including business type and UEI number, and document their experience in the relevant line of work and contracting history as both prime and subcontractors. The form requires submission of completed projects from the last three years with contract amounts, descriptions, completion dates, and owner contact information. Contractors must also list current contractual commitments running concurrently with the proposed work, including contract numbers, dollar amounts, percentage completion, and expected completion dates. The questionnaire addresses past performance through questions regarding failed work completions and use of performance bonds. Additionally, contractors must specify their organizational capacity, including minimum and maximum employee availability, payroll status, and estimated progress rates. The form requires detailed information on key personnel, their positions, years of experience, and relevant work history. Contractors must provide a comprehensive list of all equipment and vehicles to be used, including maintenance plans, and describe their quality control procedures, safety plans, and proposed work schedule. A certification section requires the signing official to attest that all information provided is complete and accurate.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 12444526Q0052.pdf | ||
| Q and A.pdf | ||
| Site Visit Announcement 12444526Q0052_.pdf | ||
| C04d Wage Determination 2015-4897.pdf | ||
| C04c Schedule of Items.xlsx | XLSX spreadsheet | |
| 12444526Q0052.pdf | ||
| C04a Statement of Work Campus Tree Work.docx | DOCX document |
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Text version
Attachment F – Experience Questionnaire
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
UEI (Formerly DUNS #) _____________________ E-Mail #_____________________
2. SUBMITTED TO (office Name and Address)
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 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 three years:
CONTRACT
AMOUNT
TYPE OF PROJECT/DESCRIPTION
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF OWNER/PERSON TO CONTACT FOR PROJECT INFORMATION
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
CONTRACT
NUMBER
DOLLAR AMT.
OF AWARD
| NAME, ADDRESS, AND TELEPHONE NO. OF BUSINESS/GOVERNMENT AGENCY INVOLVED |
| AWARDED |
(Units)
PERCENT
COMPLETED
DATE CONTRACT
COMPLETED
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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:
Previous edition is obsolete (OVER) FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
a. (1) Minimum number of employees: _____ and Maximum number of employees: _____
b. Are employees regularly on your payroll: Yes No
c. 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:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
11. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.
12. Contractor Inspection/Quality Control, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products & materials to be used on this project, a brief safety plan, and your planned schedule of work.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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 name 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 .