A14 - Experience Questionnaire.pdf
PDF 183 KB Posted
- Attached to
- GAOA Buck Hall Recreation Phase 1 Renovation
- Solicitation number
- 12445226R0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the Forest Service to evaluate contractor qualifications for federal contracts, specifically for trail-related work projects.
The form requires contractors to provide comprehensive business information including company type (company, corporation, non-profit, co-partner, or individual), DUNS number, and taxpayer ID. Contractors must document their years of experience in their line of work and specify experience as prime contractors versus subcontractors. The questionnaire requires detailed descriptions of up to five relevant projects completed in the past three years, including project location, contract amount, period of performance, specific services provided (trail type, length, equipment used, tasks performed, and trades involved), and contact information for project references. Additional sections address contract completion history, contract management capabilities including employee count and equipment availability, subcontracting plans, small business subcontracting efforts, and experience of principal business individuals. The form includes a certification statement in which the respondent attests to the accuracy and completeness of all statements and authorizes named references to provide verification information to the Forest Service. Supplemental sheets may be attached to provide additional information beyond the space available on the standard form.
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Text version
Attachment 8
ATTACHMENT 13
EXPERIENCE QUESTIONNAIRE
Instructions: See Item No. 10, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No.
e-mail:
2. Type of Business __Company __Co-Partner __Corporation __Individual __Non-profit
DUNS No. _____________________________
Taxpayer ID No.
3. How many years experience do you have in this line of work? ____Yrs
4. How many years experience as a prime contractor? _____ Subcontractor? ___
5. List the relevant current/past projects for your business in the last 3 years:
a. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
b. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
c. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
d. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
e. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
Attach supplemental sheets if space above is not sufficient
6. Have you ever failed to complete any work awarded to you? __yes __ no. If yes, specify location(s) and reason(s) why.
7. Contract Management:
a. No. of employees: b. Are employees regularly on your payroll: __yes __ no
c. Specify contractor owned equipment (indicate size & capacity) to be used for this contract
d. Tasks to be subcontracted:
e. Provisions to secure additional equipment or personnel:
f. Past experience in managing multiple contracts simultaneously:
(ADDITIONAL SHEETS MAY BE ATTACHED TO SUPPLEMENT THIS FORM)
8. Small Business Subcontracting Efforts (List proposed subcontractors to be used on the contract and indicate the type of business (i.e. Small Business, Women Owned, Small Disadvantaged)
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. REMARKS: (PLEASE NOTE ADDITIONAL SHEETS MAY BE ATTACEHD TO SUPPLEMENT THIS FORM)
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:
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