Experience Questionnaire.docx

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Haycamp Common Stand Exam Service Contract
Solicitation number
1284LM27Q0007
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This is a USDA Forest Service Experience Questionnaire form designed to evaluate contractor qualifications and capability for the Haycamp Common Stand Exam Service Contract (Solicitation 1284LM27Q0007) on the San Juan National Forest, Dolores Ranger District. The questionnaire must be completed and submitted by prospective contractors to demonstrate their suitability for this 100% small business set-aside opportunity, with quotes due via email to sarah.cotton@usda.gov no later than November 27th, 2026.

The form requires contractors to provide comprehensive information including years of experience in the relevant line of work, prime and subcontractor experience, details of projects completed within the last three years with contract amounts and owner references, and a listing of all concurrent contractual commitments. Contractors must also disclose whether they have failed to complete awarded work or required performance bonds, confirm site visits, identify the minimum and maximum number of employees available for the project and their payroll status, specify equipment available, provide estimated rates of progress (such as acres per man-day), and list principal individuals who will directly participate in the contract with their positions, years of experience, and work magnitude/type. The form includes a certification section requiring the certifying official's signature, affirming the completeness and accuracy of all statements and authorizing the Forest Service to verify the contractor's capability through named references.

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EXPERIENCE QUESTIONNAIRE CONTINUED

9. Employees and equipment that will be available for this project:

a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:______________________________________________________

d. 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. (Who will directly be involved in this contract?)

Individual’s Name
Present Position
Years of Experience
Magnitude and Type of Work

11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.

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

b. SIGNATURE (Sign in ink)
13. DATE

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Microsoft_Word_Document.docx

USDA Forest Service

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

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 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

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 Complete

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. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No

8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

EXPERIENCE QUESTIONNAIRE CONTINUED

9. Employees and equipment that will be available for this project:

a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:______________________________________________________

d. 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. (Who will directly be involved in this contract?)

Individual’s Name

Present Position

Years of Experience

Magnitude and Type of Work

11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.

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

b. SIGNATURE (Sign in ink)

13. DATE

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