A6 Attachment 3 Experience Questionnaire.pdf

164 KB Posted

Attached to
Airport Fire BAER Weed Treatment
Solicitation number
127EAV25Q0078
Issued by

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This Experience Questionnaire is for an Airport Fire BAER (Burned Area Emergency Response) Weed Treatment contract with solicitation number 127EAV25Q0078. The document requires potential contractors to provide detailed information about their qualifications for performing insecticide spraying services, including company details, California Qualified Applicator License status, experience level, workforce capacity, technical approach, past performance, and current contractual commitments. Key sections require contractors to specify their minimum and maximum progress rates, number of employees, equipment and safety plans, references from previous similar projects, and a certification of the accuracy of the provided information. The questionnaire is designed to assess a contractor's capability to conduct weed treatment services following a fire event, with a focus on demonstrating relevant experience, technical competence, and operational readiness.

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Other files

File Type Posted
A6 WD 2015-5645.pdf PDF
A6 RFQ 127EAV25Q0078.pdf PDF
A6 SOI 127EAV25Q0078.xlsx XLSX spreadsheet

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Experience Questionnaire Airport Fire BAER Weed Treatment

127EAV25Q0078

1. Contractor Name:

2. POC:

3. Address:

4. Telephone Number:

5. Email Address:

6. UEI:

7. Small Business: Yes/No

2. Do you have a California Qualified Applicator License or Certificate (QAL/QAC)? Yes/No

3. How many years of experience do you or your company have in performing insecticide spraying services?

4. Estimate rate of progress (Such as acres/day, miles/day, or other rate):

Minimum progress rate: Maximum progress rate:

5. Employees that will be available for this work:

a. Minimum number of employees: and Maximum number of employees:

b. Are employees regularly on your payroll? Yes No

6. Please provide references for the last three (3) companies you have performed insecticide service:

Company and Point of Contract Email Address Phone Number

7. List the name (s) of the key personnel and qualifications who will be performing the insecticide spraying services:

8. Describe technical approach to performing the work – Equipment, safety plan and schedule. (Use another sheet of paper if additional space is needed).

9. Past Performance - List below the projects your business has completed within the last three (3) years which are similar in scope and scale to this job:

Contract Number

Contract Amount

Location of Work

POC Name, email, phone

Description of Project

Location of Work

Location of work

10. List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:

Contract # Dollar Amount Company/Agency Location of work When will the contract be completed?

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 Government with any information needed to verify my capability to perform this project.

13a. CERTIFYING OFFICIAL'S NAME AND TITLE

13b. SIGNATURE 14. DATE

Contractor Name:
POC:
Address:
Telephone Number:
Email Address:
UEI:
2 Do you have a California Qualified Applicator License or Certificate QALQAC YesNo:
3 How many years of experience do you or your company have in performing insecticide spraying services:
4 Estimate rate of progress Such as acresday milesday or other rate Minimum progress rate Maximum progress rate:
undefined:
undefined_2:
5 Employees that will be available for this work:
undefined_3:
and Maximum number of employees:
No:
Company and Point of ContractRow1:
Email AddressRow1:
Phone NumberRow1:
Company and Point of ContractRow2:
Email AddressRow2:
Phone NumberRow2:
Company and Point of ContractRow3:
Email AddressRow3:
Phone NumberRow3:
7 List the name s of the key personnel and qualifications who will be performing the insecticide spraying services:
8 Describe technical approach to performing the work Equipment safety plan and schedule Use another sheet of paper if additional space is needed:
Contract NumberRow1:
Contract AmountRow1:
Location of WorkRow1:
POC Name email phoneRow1:
Description of Project:
Contract NumberRow1_2:
Contract AmountRow1_2:
Location of WorkRow1_2:
POC Name email phoneRow1_2:
Description of Project_2:
Contract NumberRow1_3:
Contract AmountRow1_3:
Location of workRow1:
POC Name email phoneRow1_3:
Description of Project_3:
Contract Row1:
Dollar AmountRow1:
CompanyAgencyRow1:
Location of workRow1_2:
When will the contract be completedRow1:
Contract Row2:
Dollar AmountRow2:
CompanyAgencyRow2:
Location of workRow2:
When will the contract be completedRow2:
Contract Row3:
Dollar AmountRow3:
CompanyAgencyRow3:
Location of workRow3:
When will the contract be completedRow3:
Contract Row4:
Dollar AmountRow4:
CompanyAgencyRow4:
Location of workRow4:
When will the contract be completedRow4:
13a CERTIFYING OFFICIALS NAME AND TITLE:
Date1_af_date:

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