Atch_5_Experience_Questionnaire.xls

XLS spreadsheet 31 KB Posted

Attached to
Indiana Dunes National Park-HVAC Preventative Main
Solicitation number
140P6326Q0035
Issued by

About this file

This is an Experience Questionnaire form required for contractor submission in response to the Indiana Dunes National Park HVAC Preventative Maintenance solicitation (140P6326Q0035) issued by the National Park Service Midwest Region under the Department of the Interior.

The questionnaire requests comprehensive information about the contractor's qualifications and capacity to perform HVAC preventative maintenance services. Required submission elements include: contractor business information and type (corporation, non-profit, individual, or co-partner); years of experience in HVAC work and as a prime contractor; detailed documentation of projects completed within the last three years with contract amounts, project types, completion dates, and reference contacts; current contract commitments with contract numbers, award amounts, and completion status; performance history regarding any incomplete work or performance bond requirements; organizational capacity including minimum and maximum employee availability, payroll status, and equipment inventory; experience credentials of principal personnel assigned to the project; and financial responsibility verification through either a financial institution letter or direct account status documentation. The form also requires contractor certification that all statements are accurate and authorizes references to verify capability to perform the work. This template allows for manual completion or electronic submission via MS Excel, with additional remarks space available as needed.

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Text version

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 the projects your business has completed in the last 3 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 .