Experience_Questionaire.docx

United States Department of Agriculture

Forest Service

Rocky Mountain Acquisition Management

2150 Centre Ave., Bldg. E Fort Collins, CO 80526

USDA – Forest Service

EXPERIENCE QUESTIONNAIRE

(Ref. FSH 6309.31 and 41 USC 1)

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

1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.

2. SUBMITTED TO (office Name and Address) USDA Forest Service, Region 5 Northern California Acquisition Service Area 2550 Riverside Drive Susanville CA 96130

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 of 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

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

(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: ☐ Yes ☐ No 8d. Did you look at the project site(s) on-the-ground? ☐ Yes ☐ No

9. Organization and work that will be available for this project.

a. Minimum number of employees: _____ and; 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 (if applicable) Minimum progress rate: _________________________________ and; maximum progress rate: _________________________________

e. Subcontractors (if any) Name Experience % of work to be completed by sub

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 you own or have available through a rental agreement to be used on this contract/agreement. Provide a detailed description of the Equipment including your maintenance and cleaning plans.

12. Explain your quality control plan to assure contract specifications are met. What is your plan for safety at the job site(s)? Identify the hazards specific to the site(s) and the types of work being performed and how you plan to mitigate the risks.

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

8d. How extensive was your site visit for this project? (e.g., ‘drove by some areas;’ ‘walked area.’) What did the site visit reveal about the comparative difficulty of the project—e.g., the problems that are likely to be encountered during performance?

9. Describe your proposed work plan indicating how the project will be accomplished. What sequence of work are you planning to ensure timely completion of the project? (i.e., what areas or work processes will be done first? next? last?) How many and what types of resources (personnel and equipment) will be assigned to the 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 person’s 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 Name and Title

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