ExpQuestionnaire.pdf

USDA Forest Service (3/03)

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name & Address)

3. Business Company Partnership Corporation Individual Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation________________

5. How many years experience in contracting have you or your business had as a (a) prime contractor ________ and/or (b) sub-contractor ______?

6. List below the projects your business has completed within the last three years:

Contract Amount

Type of Project

Date

Completed

Name, Address, and Telephone No. of Owner/Person to Contract for Project Information

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

Contract

Amount

Dollar Amt

Of Award

Name, Address, and Telephone No. of Business/Government Agency Involved

Awarded

(Units)

Percent

Completed

Date Contract

Completed

8a. Have you ever failed to complete any work awarded to you? _____ Yes _____ No

8b. If “Yes” to either item 8a specify location(s) and reason(s) why:

9a. How do you plan on maintaining cleaning standards and taking corrective action in the case that cleaning does not meet standards?

9b.

a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________

b. Are employees regularly on your payroll? _____ Yes _____ No

c. Specify equipment available for this contract:_______________________________________________

e. Describe the safety measures and procedures employed by your firm. Specifically address: 1) how maximum safety is ensured for both employees and the public who may be on the work site during contract performance, 2) transportation safety for employees to and from work, and 3) First Aid and evacuation plans in the event of an illness or injury.

Include Past Performance definitions so contractor know what they are being rated on.

i. Quality of services: Demonstrated ability to perform services in accordance with contract specifications. Conformance to good standards of workmanship.

ii. Customer Satisfaction: Satisfaction of end users with the contractor's completed services.

iii. Business relations: Effective management, ability to manage projects involving subcontracts, working relationship with the contracting officer and technical representatives, reasonable/cooperative behavior, flexibility, effective contractor recommended solutions, businesslike concern for government's interests.

v. Timeliness of performance: compliance with delivery schedules; reliability; responsiveness to technical direction, no assessment of liquidated damages.

Use a separate sheet of paper if necessary.

10. List below the experience of the principal individuals of your business:

Individual’s Name Present Position Years of Exp.

Type of Work

11. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):

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.

12a.Certifying Official’s Name and Title

12b. Signature (Sign in Ink) 13. Date