B09_Solicitation_attach_5_Experience_Questionaire_0001.xls

XLS spreadsheet 38 KB Posted

Attached to
PIPE - REHAB VISITOR CENTER RESTROOMS
Solicitation number
140P6326Q0001
Issued by

About this file

The file is an Experience Questionnaire for a construction services solicitation at Pipestone National Monument, specifically for pipe rehabilitation of visitor center restrooms. The document requires potential contractors to provide comprehensive details about their business, including years of experience, past wastewater projects completed in the last 5 years, current contract commitments, organizational capacity, key personnel qualifications, and financial responsibility.

The questionnaire captures critical information for the National Park Service to evaluate contractor capabilities, such as minimum and maximum employee numbers, equipment availability, principal individuals' experience, and financial standing. Contractors must certify the accuracy of their submission, with provisions to provide additional documentation like financial institution letters. The solicitation (140P6326Q0001) is issued by the Department of the Interior National Park Service Midwest Region and seeks detailed professional background information to assess contractor suitability for the restroom rehabilitation project.

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Sheet1

1. Contractors Name, Address, & Telephone No.:2. Type of Business
Name:
Address:Company
Corporation
Non-profit Org
Telephone No.:Co-partner
Individual
3. How many years experience do you have in this line of work?Years
4. How many years experience as a prime contractor?Years
5. List waste water type projects your business has completed in the last 5 years:
CONTRACT
AMOUNTTYPE OF
PROJECTDATE
COMPLETEDNAME, ADDRESS & TELEPHONE NO.TO

CONTACT FOR INFORMATION

6. List all of your firms current contract commitments:
CONTRACT
NUMBERAWARD
AMOUNTNAME, ADDRESS, & PHONE NO.
TO CONTACT FOR INFORMATIONPERCENT
COMPLETEDDATE

COMPLETED

7a. Have you ever failed to complete any work awarded to you?YesNo
7b. Has work ever been completed by performance bond?YesNo
7c. If "Yes" to either item 7a or 7b, specify locations and reason why:
8. Organization that will be available for this project:
a. Minimum No. of employees:and maximum No. of employees:
b. Are employees regularly on your payroll?YesNo
c. Specify equipment available for this project:
9. List the experience of principal individuals to be used on this project:
INDIVIDUALS
NAMEPRESENT
POSITIONYEARS
EXPERIENCETYPE OF WORK
10. Financial Responsibility:
(in lieu of this, you may submit a letter from your
financial institution that addresses the status and standing of your accounts)
Name of Financial Institution
Address:
Contact Name
Contact Phone Nbr
11. Remarks
CERTIFICATION: I certify that all 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 National Park Service with any information needed to verify my capability to perform this project.
NAMETITLEDATE

EXPERIENCE QUESTIONNAIRE

Instructions: This form may be completed manually or by using MS Excel. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

Sheet2

Sheet3

File details come from the government source that posted it. Updated .