Atch_2_Experience_Questionnaire.xls
XLS spreadsheet 38 KB Posted
- Solicitation number
- 140PP027Q0014
- Issued by
- Not on record
About this file
This is an Experience Questionnaire form used by the National Park Service to evaluate contractor qualifications and capability for federal contract performance. The form requires contractors to provide comprehensive information including business type and contact details, years of experience in their line of work and as a prime contractor, and a detailed list of projects completed within the last three years with contract amounts and reference contacts. Contractors must disclose all current contract commitments with award amounts and completion status, and answer questions regarding any failure to complete awarded work or reliance on performance bonds, with explanations required if applicable. The form also requests organizational capacity information such as minimum and maximum employee availability, payroll status, and equipment available for the project.
Additionally, the questionnaire requires contractors to list principal individuals assigned to the project with their positions and relevant experience, provide financial responsibility documentation through either a financial institution letter addressing account status or direct financial institution contact information, and include any additional remarks in the designated space. The form concludes with a certification statement in which the contractor attests to the accuracy and completeness of all provided information and authorizes references to verify capability to perform the project. This questionnaire is associated with Solicitation Number 140PP027Q0014 for Curecanti National Recreation Area Septic Pump Truck Tank Replacement work.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140PP027Q0014.pdf | ||
| Atch_3_DOL_Wage_Determination_2015-5435.pdf | ||
| Atch_1_SOW.pdf |
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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 | |||||||
| AMOUNT | TYPE OF | ||||||
| PROJECT | DATE | ||||||
| COMPLETED | NAME, ADDRESS & TELEPHONE NO.TO |
CONTACT FOR INFORMATION
| 6. List all of your firms current contract commitments: | |||||
| CONTRACT | |||||
| NUMBER | AWARD | ||||
| AMOUNT | NAME, ADDRESS, & PHONE NO. | ||||
| TO CONTACT FOR INFORMATION | PERCENT | ||||
| COMPLETED | DATE |
COMPLETED
| 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 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? | Yes | No | ||||||||||||
| c. Specify equipment available for this project: | ||||||||||||||
| 9. List the experience of principal individuals to be used on this project: | ||||||||||||||
| INDIVIDUALS | ||||||||||||||
| NAME | PRESENT | |||||||||||||
| POSITION | YEARS | |||||||||||||
| EXPERIENCE | TYPE 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. | ||||||||||||||
| NAME | TITLE | DATE |
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
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