ExperienceQuestionnaire.pdf

USDA Forest Service

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 and Address)

R1, IMAT, IPNF

3815 Schreiber Way Coeur d Alene, ID 83815

3. Business [ ] Company [ ] Co-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 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 with work relevant to this project, experienced with Facility Construction and Remodel. See Past Performance ratings on the next page. Use additional sheets if necessary.

Contract Amount or Value of Project

Type of Project and list types of work accomplished

Date Completed

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

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

Contract Number

Dollar Amt.

of Award

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

Awarded (Units)

Percent Completed

Date Contract Complete

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No 8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

EXPERIENCE QUESTIONNAIRE CONTINUED

9.

Past Performance will be evaluated on the following:

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. Cost Control: Ability to complete contracts within budget (at or below); reasonableness of price change proposals submitted; providing current, accurate, and complete billings.

iv. 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.

10. List below the experience of the principal individuals of your business: (Who will directly be involved in this contract?) Use additional sheet if necessary. Include the individual and their experience for the role as On Site Representative.

Individual’s Name Present Position Years of Experience

Magnitude and Type of Work

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

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO

SUCCESSFULLY COMPLETE THIS PROJECT.

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

b. SIGNATURE (Sign in ink) 13. DATE

EXPERIENCE QUESTIONNAIRE CONTINUED

The following is added:

Biobased Products list of designated items at http://www.biopreferred.gov.)

Quoter shall identify the biobased products to be purchased and used under this contract. For each biobased product, specify the name of the manufacturer, cost of each product, and the intended use of each of the materials that are to be used in carrying out the requirements of the contract. For each biobased product, the Quoter shall specify the percentage of biobased content, and for the USDA-designated biobased content products, the Offeror shall demonstrate that the products to be used under this contract will contain the percentage specified in the USDA recommendations or the highest level of biobased material practicable, consistent with USDA's recommended percentages of biobased content.

The Quoter shall document prior experience in specifying, purchasing, using, and installing biobased products. The Quoter shall provide a list of all relevant contracts over the past 3 years involving the specification, purchase, and/or use of biobased products. The Quoter shall include a list of the biobased products specified, purchased, used, and installed.

The above information shall be provided for all proposed subcontractors in the same format and level of detail as prescribed for the Quoter.

Attach additional sheets, as necessary.

http://www.biopreferred.gov/