1284LL26Q0012 Experience Questionnaire.pdf
PDF 114 KB Posted
- Solicitation number
- 1158695
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for federal contract opportunities. The form requires prospective contractors to provide comprehensive information about their business capabilities, experience, and personnel.
Key information requested includes: contractor name, address, telephone number, and email; business structure (company, corporation, partnership, individual, or non-profit organization); years of experience in the specific line of work and contracting history as both prime and sub-contractors; detailed project history from the past three years or currently ongoing work with contract amounts, project types, completion dates, and reference contact information; disclosure of any failed work completion or performance bond requirements with explanations; organizational capacity including minimum and maximum employee availability and payroll status; equipment resources available for the contract; experience and qualifications of principal individuals including their names, current positions, years of experience, and work magnitude/types; and remarks section for additional information. The form concludes with a certification statement requiring the certifying official to attest that all provided information is complete and correct, with signature, printed name, title, and date required. Contractors must authorize the Forest Service to contact named references to verify capability to perform the project.
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Text version
USDA Forest Service (1/00)
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, Address, Telephone Number, and Email
2. Submitted to (Office Name & 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 (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount
Type of Project Ongoing or
Date Completed
Name, Address, and Telephone No.
of Owner/Person to Contract for
Project 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 item 7a or 7b specify location(s) and reason(s) why:
8. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________
b. Are employees regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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.
12a.Certifying Official’s Name and Title
12b. Signature (Sign in Ink) 13. Date
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