A6 Attachment 4 Experience Questionaire.pdf
PDF 116 KB Posted
- Solicitation number
- 12441923Q0143
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an experience questionnaire for Attachment 4 of Solicitation Number 12441923Q0143 from the Department of Agriculture Forest Service to construct bathhouse doors at the Cedar Lake area of the Ouachita National Forest. The questionnaire collects details on the contractor's experience including the number of years in business, prior federal contracts with award amounts and contact information, current commitments, bonding history, available equipment and staffing, and principal personnel experience. It requests credit and banking references for responsibility determination and includes a certification for the provided information.
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Other files
| File | Type | Posted |
|---|---|---|
| A6 Attachment 3 Wage Determination.pdf | ||
| A6 Attachment 2 Pictures.pdf | ||
| A6 Attachment 1 Statement of Work.pdf | ||
| A6 12441923Q0146 RFQ.pdf |
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Text version
ATTACHMENT 4
Attachment 4
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 experience do you have in this line of work____Yrs
4. How many years experience as a prime contractpr_____ subcontractor___
5. List the projects your business has completed in the last 3 years from the solicitation issuance date
CONTRACT
NUMBER
AWARD
AMOUNT
NAME ADDRESS & PHONE
NO. TO CONTACT FOR INFO.
PERCENT
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
NAME ADDRESS & PHONE NO. TO CONTACT
FOR INFO.
PERCENT
COMPLETED
7a. Have you ever failed to complete any work awarded to you? __yes __ no
ATTACHMENT 4
Attachment 4
7b. Has work ever been completed by performance bond? __yes __ no
7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
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
b. Banking Information.
Company Name/Address Point of Contact Telephone number TYPE OF WORK
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:
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