A-3_Experience Questionaire.pdf
PDF 133 KB Posted
- Solicitation number
- 12443925Q0027
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Experience Questionnaire for a Custodial/Janitorial Services solicitation (No: 12444825Q0027) for the Lee Ranger District and North River Ranger District within the George Washington and Jefferson National Forests in Virginia. The form requires potential contractors to provide detailed information about their business, including years of experience, current contract commitments, past project history, organizational capacity, and key personnel qualifications. The questionnaire is designed to help the Forest Service assess a contractor's capability and responsibility for performing janitorial services, with sections covering business type, project experience, employee information, equipment availability, and credit/banking references.
The form includes sections for contractors to list up to three most relevant projects completed within the past three years, disclose any previous contract completion issues, specify organizational details such as employee count and equipment, and provide information about principal individuals' experience. The document concludes with a certification statement where the contractor affirms the accuracy of the provided information and authorizes the Forest Service to verify their capability to perform the project. No specific contract award amount, response dates, or detailed service requirements are specified within this attachment.
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Text version
Solicitation No: 12444825Q0027 Custodial/Janitorial Services
Lee Ranger District and North River Ranger District George Washington and Jefferson National Forests, VA
Attachment A-3
NAME, ADDRESS, E-MAIL, & PHONE NO. TO
CONTACT FOR INFORMATION.
AWARD
AMOUNT
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No. Email 2. Type of Business
Company Co-Partner Non-profit Corporation Individual
3. How many years of experience do you have in this line of work Yrs
4. How many years of experience as a prime contractor subcontractor
5. List no more than 3 most relevant projects your business has performed within 3 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
NAME, ADDRESS, E-MAIL, &
PHONE NO. TO CONTACT
FOR INFORMATION.
DATE
COMPLETED
DESCRIPTION OF
WORK PERFORMED
6. List all of your firms current contract commitments
NUMBER
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 location(s) and reason(s) why
PERCENT
Solicitation No: 12444825Q0027 Custodial/Janitorial Services
Lee Ranger District and North River Ranger District George Washington and Jefferson National Forests, VA
Attachment A-3
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: yes no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References Company Name/Address Point of Contact Telephone number TYPE OF WORK
N/A N/A N/A
b. Banking Information.
Company Name/Address Point of Contact Telephone number TYPE OF WORK
N/A N/A N/A
11. REMARKS
CERTIFICATION: I certify that all of 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 Forest Service with any information needed to verify my capability to perform this project:
Name: Title: Date:
File details come from the government source that posted it. Updated .