ExperienceQuestionnaire.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 performed and 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

Complete d

Date

Contract

Completed

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

9. Organization and work that will be available for this project:

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:_______________________________________________

d. 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.

Past Performance definitions (pertains to # 6 - 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. 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.

Use a separate sheet of paper if necessary.

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

Individual’s Name and Copy of

Resume

Present Position Years of

Exp.

Type of Equipment operated and/or

Type of work (attach resume)

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