C4d_ Attachment D Experience Questionnaire 12444626Q0062.pdf
PDF 268 KB Posted
- Attached to
- Mark Twain NF Wellness Presentation
- Solicitation number
- 12444626Q0062
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire for a USDA Forest Service contract opportunity (Reference 12444626Q0062), used to evaluate contractor qualifications and capability to perform solicited work.
The form requires contractors to provide comprehensive organizational and experience information, including company details, years of experience in the relevant line of work, and prime/sub-contractor history. Contractors must list projects completed within the last three years with contract amounts, project descriptions, completion dates, and owner contact information for verification purposes. The questionnaire also requires disclosure of all concurrent contractual commitments, including contract numbers, award amounts, government/business agency information, percentage completion, and expected completion dates. Contractors must disclose any failure to complete awarded work or instances where performance bonds were used. Additionally, the form requests information on workforce availability (minimum and maximum employee counts), payroll status, and estimated progress rates. Contractors must detail principal individuals' experience, all equipment and vehicles planned for use with maintenance descriptions, self-inspection procedures for quality control, safety plans, work schedules, and information on bio-based products and materials to be used. The questionnaire concludes with a certification statement signed by an authorized official attesting to the accuracy and completeness of all submitted information. Extra space may be used in Box 13 (Remarks) if needed to fully answer any question.
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Text version
Attachment C – Experience Questionnaire: 12444626Q0062
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 .