C04d - Exp Questionnaire.pdf
PDF 226 KB Posted
- Solicitation number
- 12444627Q0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form that contractors must complete and submit as part of their offer package for the Superior National Forest Access Control Repairs contract opportunity.
The questionnaire requires offerors to provide basic company information including name, SAM UEI number, email address, and point of contact details. Contractors must identify their business type (company, corporation, non-profit organization, co-partner, or individual) and document years of experience in the field as both prime contractors and subcontractors. The form requests detailed project history for the past three years, including contract amounts, project types, completion dates, and reference contacts. Offerors must also list any concurrent contractual commitments that may overlap with this project, including contract numbers, amounts, project types, and estimated completion dates. Additional sections address past performance issues, specifically whether the contractor has failed to complete awarded work or required performance bond completion, with space to explain any affirmative responses. The questionnaire requires detailed information about vehicle upfitting services, including employee assignments, experience levels, and work types. Offerors must provide warranty information, delivery terms, organizational capacity (minimum and maximum employee counts), payroll status, equipment and facilities available, and estimated progress rates. The form requires a narrative describing the contractor's anticipated project approach and includes a certification statement affirming the accuracy of all submitted information and authorizing the Forest Service to verify contractor capability through named references. Responses must be signed by an authorized representative with title and date.
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Text version
Superior NF – Access Control Repairs Offer Submission Package
Experience Questionnaire (Please complete and submit the following with your offer.)
By submitting the offer, the Contractor agrees to all terms, conditions, clauses, and provisions included in the solicitation and agrees to furnish any awarded items at the price set in the schedule. The offer is valid for 60 after the closing date of the solicitation unless a formal extension is granted by the contractor.
OFFEROR NAME __________________________________________________________
OFFEROR SAM UEI NUMBER _________________________________________________
OFFEROR EMAIL ADDRESS ________________________________________________
OFFEROR POINT OF CONTACT (NAME AND PHONE) _________________________________
Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.
Please list NA for inapplicable items.
1. Contractor's Name, Address & Telephone Number 2. Type of Business
____ Company
____ Corporation
____ Non-profit Organization
____ Co-partner
____ Individual
3. How many years of experience do you have in this line of work? ___________________
4. How many years of experience as a prime contractor? _________ subcontractor? ________
5. List the projects your business has completed in the last 3 years.
Contract Amount
Type of Project Date Completed
Name and Telephone Number to Contact For Information
6. List contractual commitments running concurrently with the work contemplated by this soliciation.
Contract Number
Contract Amount
Type of Project Est. Date of Completion
Name and Telephone Number to Contact For Information
7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no
7b. Has work ever been completed by performance bond? ____ yes ____ no
7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
8. List any special features of the supply reuqired for effective program performance.
9. Provide information on the probable life of the items selected in comparison to unchosen compatible items.
10. Provide warranty information and the avialability of maintenance and repair.
11. Detail delivery terms.
12. Organization that will be available for this project:
a. Minimum No. of employees: _______________ Maximum No. of employees: ________________
b. Are employees regularly on your payroll? ____ yes ____ no
c. Specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract:
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: __________________________ Maximum progress rate: _____________________
13. List the employees that would be assigned to perform vehicle upfitting services at the work site on this contract and their experience with vehicle upfitting:
Individual's Name Present Position Years Experience Type of Work
14. Please provide a brief narative which describes your anticipated approach to this project. The space below is not adequate for response. Please provide your response on an additional page(s).
15. Remarks: Additional pages may be added to provide additional information in this section.
CERTIFICATION: I certify that all of the statements made above 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.
Signature Title Date
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