Exhibits for Section J.pdf

Road Construction Services

Exhibit A: CONTRACTOR’S FINANCIAL INFORMATION SHEET

SECTION 1 – GENERAL INFORMATION

1A.NAME 2. TYPE OF ORGANIZATION (CHECK ONE)

A. Sole Proprietorship F. LLC

1B. STREET ADDRESS B. General Partnership G. Joint Venture

C. Limited Partnership H. Non-Profit/Education 1C. CITY 1D. STATE 1E. ZIP/POSTAL D. Corporation I. Other: Specify

E. Subchapter S.

3. TAXPAYER ID NUMBER : 4. PHONE NUMBER 5. FAX NUMBER

6. SAM UNIQUE ID NUMBER: 7. CELLPHONE NUMBER

8. KIND OF PRODUCT OR SERVICE PROVIDED: 9. EMAIL ADDRESS

10. KIND OF BUSINESS- Specify one block (plus “J” if applicable)

A. LARGE BUSINESS E. EMERGING SMALL

BUSINESS

I. INDIAN SDB

B. SMALL BUSINESS F. VETERAN SMALL BUSINESS J. HUB ZONE - Also

C. SMALL DISADVANTAGED BUSINESS G. SERVICE DISABLED

VETERAN OWNED SMALL

BUSINESS

K. Other: Please Specify

D. WOMAN OWNED SMALL BUSINESS H. INDIAN SMALL BUSINESS

11. OWNERSHIP INFORMATION – PARTNERS – PRINCIPALS - OTHERS

NAME TITLE

13.

14.

15.

16. Questions. If “Yes” to any below, attach detailed information. Yes No A. Have you/your affiliates ever filed for bankruptcy?

B. Do you have any judgments, liens, pending suits?

C. Do you have any contingent liabilities?

D. Have you/your affiliates discontinued business operations with outstanding debts?

SECTION II. GOVERNMENT FINANCIAL AID AND INDEBTEDNESS

If “Yes”, attach detailed information.

Yes No

17. Are you delinquent on any Federal Debt (OMB Circular 129)

18. Do you owe the Government for any contract or other claims?

19. Are you currently receiving Government Financing? (Bonds, Loans, Advanced Payments, Progress Payments, Other)

19a. Are you now in or pending Default on ANY Obligations (i.e. Banks, Financial Institutions, Suppliers, Other)? IF yes please attach detailed information.

Solicitation Number:

Forest/State:

Road Construction Services

Exhibit B: PERFORMANCE RELEVANCY QUESTIONNAIRE

Provide the following information requested in this format for each of the projects/contracts being described. Projects may be ongoing and cannot have been completed any later than 3 years prior to the to this issue date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify. Use as much space as required. OFFEROR SHOULD PLACE

THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE.

INSTRUCTIONS: If extra space is needed use the reverse. Mark "X" in appropriate boxes.

CONTRACTOR NAME, ADDRESS & TELEPHONE/Unique Sam ID

How many years do you or your firm have in the line of work contemplated by this solicitation ______? How many years experience in contracting have you or your business had as a (a) prime contractor _____ and/or (b) sub-contractor _____?

PART 1 - PAST / CURRENT PROJECTS

List below up to 5 projects your business has completed within the last 3 years similar in scope to the solicitation:

Contract Amount Type of Project Date Completed Name Address & Telephone No. of Person to Contact for Project Information.

List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract No. Dollar Amount of Project

Name, Address & Phone No. of Business Govt./Agency

Awarded (Units)

Completed

Date Contract Completed

Have you ever failed to complete any work awarded to you? Yes ( ) No ( ) Has work ever been completed by performance bond? Yes ( ) No ( ) If "Yes" to either item above specify location(s) and reason(s) why:

PART 2 – SPECIALIZED EXPERIENCE – For each of the projects listed above, address the following comments on a separate sheet:

a) Describe the specific elements of the work performed by your firm.

b) Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on Forest Service projects.

c) Address any technical areas about this project you consider uniquely relevant to this solicitation.

d) Point of Contact for Owner/Government agency Contracting Officer and or inspector; include a current phone number and facsimile number. Email address is also desired.

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.

Certifying Official's Printed Name and Title Signature Date

Solicitation:

Forest/State:

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire

For Official Use Only

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? Yes No

L. Contractor’s Role: Prime Contractor Subcontractor Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

solicitation number:

Past Performance Questionnaire

For Official Use Only

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

Section 4: Performance Information

In the table below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Past Performance Questionnaire

For Official Use Only

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Note: The following are SAMPLE questions. Past Performance evaluation teams MUST construct a simple and concise Past Performance Questionnaire, tailored to seek out key information tied to the significant aspects of the planned acquisition. Avoid questions that can be answered with a “yes” or “no” but instead include probing and direct questions to draw out the required information desired.

The Contractor: E V S M U N/A

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

SUPPORTING INFORMATION:

2. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

SUPPORTING INFORMATION:

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

SUPPORTING INFORMATION:

4. Home office participated in solving significant local problems.

SUPPORTING INFORMATION:

5. Followed approved quality control plan.

SUPPORTING INFORMATION:

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

SUPPORTING INFORMATION:

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

Past Performance Questionnaire

For Official Use Only

The Contractor: E V S M U N/A

SUPPORTING INFORMATION:

8. Provided timely resolution of contract discrepancies.

SUPPORTING INFORMATION:

9. Identified problems as they occurred.

SUPPORTING INFORMATION:

10. Suggested alternative approaches to problems.

SUPPORTING INFORMATION:

11. Displayed initiative to solve problems.

SUPPORTING INFORMATION:

12. Developed realistic progress schedules.

SUPPORTING INFORMATION:

13. Met established project schedules.

SUPPORTING INFORMATION:

14. Provided timely resolution of deficiency.

SUPPORTING INFORMATION:

15. Was responsive to contract changes.

SUPPORTING INFORMATION:

16. Provided adequate project supervision.

SUPPORTING INFORMATION:

Past Performance Questionnaire

For Official Use Only

The Contractor: E V S M U N/A

17. Paid subcontractors/suppliers in a timely manner.

SUPPORTING INFORMATION:

18. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

SUPPORTING INFORMATION:

19. Cooperated with Government personnel after award.

SUPPORTING INFORMATION:

20. How would you rate the contractor's overall performance on this contract?

SUPPORTING INFORMATION:

21. Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain.

EXPLANATION:

Yes

No

22. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

Yes

No

IF THIS WAS A GOVERNMENT CONTRACT:

Did this contract include FAR 52.219-9, Small Business Subcontracting Plan?

Yes No

If yes, did the contractor comply with the clause? Please explain.

Did this contract include FAR 52.219-8, Utilization of Small Business Concerns?

Past Performance Questionnaire

For Official Use Only

Yes No

If yes, did the contractor comply with the clause? Please explain.

Additional remarks:

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: