4. Experience Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Potter Cemetery NNIS for Hoosier National Forest
- Solicitation number
- 12444525Q0038
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is an Experience Questionnaire for a federal contract opportunity related to herbicide treatment of Non-Native Invasive Species (NNIS) on the Hoosier National Forest. The questionnaire requires detailed information from potential contractors, including business type, years of experience, past project history, current contract commitments, organizational structure, and key personnel qualifications.
The form seeks comprehensive details about the contractor's capabilities, including the minimum and maximum number of employees, equipment to be used, progress rates, and specific experience with Hand Held GPS, Shapefiles, and Avenza. Contractors must provide a work plan describing how they will accomplish the task, certify the accuracy of their statements, and include their Tax Identification Number (TIN) and DUNS number. The questionnaire is part of a solicitation (12444525Q0038) issued by the Department of Agriculture Forest Service for a project focused on post-timber harvest herbicide treatment to increase tree regeneration and reduce hazardous fuels.
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Other files
| File | Type | Posted |
|---|---|---|
| 2. Maps.pdf | ||
| 3. Wage Determination SCA 2015-4821.pdf | ||
| 1. Performance Work Statement.pdf | ||
| OM-RFQ 12444525Q0038.pdf | ||
| Schedule of Items-.pdf |
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Text version
EXPERIENCE QUESTIONNAIRE
1. Contractor’s Name, Address & Telephone #.
2. Type of Business
___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization
| 3. How many years experience do you have related to this line of work? _______ years |
| 4. How many years experience as a prime contractor? ________years |
Subcontractor? _______
5. List all the similar projects your business has completed in the last three (3) years.
| CONTRACT AMOUNT |
| TYPE OF CONTRACT WORK |
| DATE COMPLETED |
| Contact Name, Address and Tele. # |
6. List all of your firms’ current contract commitments
| CONTRACT NUMBER |
| AWARD AMOUNT |
| Contact Name, Address & Tele. # |
| Percent Completed |
| Date Contract 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 above, specify reason(s) and location(s) why.
8. Organization structure 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 to be used for this contract:
d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc…):
Progress Rate of _______________
9. List the experience of the principal individuals of your business tied to this project
| NAME |
| PRESENT POSITION |
| YRS EXP. |
| TYPE OF WORK |
10. Hand Held GPS and Shapefile experience, And/or Avenza Experience:
11. Work plan: Describe plan how to accomplish task.
TIN#__________________ Duns#_______________ CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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.
| __________________________ | ___________________________ | ___________________ | ______ | ||
| Signature | Print or Typed Name | Title | Date |
File details come from the government source that posted it. Updated .