Contractor's_Experience_questionnaire[1].pdf

CONTRACTOR'S EXPERIENCE QUESTIONNAIRE

To be completed by Contractor - return to the Contracting Officer with your proposal.

A. GENERAL INFORMATION

1. Name of Firm: ______________________________________________________

2. Address: ______________________________________________________

3. Telephone No. ______________________________________________________

4. Fax No. ______________________________________________________

5. Email address: _______________________________________________________

6. How many years’ experience do you have in facility construction/renovation? ___________

As a prime contractor? ____________ As a subcontractor? ________________

Type of business: ____ Company ____ Corporation ____ Co-Partner ____ Individual

Number of employees: _____ Are employees regularly on your payroll? ____ yes _____ no

State your past experience with managing multiple contracts simultaneously: ____________

B. PAYMENT PROTECTION INFORMATION

1. If task order is valued greater than $30,000 but less than $150,000, payment protection is required.

It may be submitted in the form of a Payment Bond or an Irrevocable Letter of Credit. Name of Company that supplies your Payment Bonds or ILC, and contact name and number:

2. Name of firm's Insurance Agency______________________________________________

3. Type of Payment Protection provided: _________________________________________

3. Address: ___________________________________________________________

4. Name of Agent: ___________________________________________________________

5. Telephone No. of Agent: ____________________________________________________

C. BANKING INFORMATION

1. Name of Bank: ___________________________________________________________

2. Address: ___________________________________________________________

3. Name of Account Representative: ____________________________________________

4. Telephone No. of Representative: ____________________________________________

D. SAFETY DATA

1. Does your firm have a Standard Operating Procedure for Safety? Yes ______No _______

2. Does your firm have a policy letter dealing with Safety? Yes _______ No _______

3. What was your accident rate for last year? ___________________________________

4. What is your accident rate to date for this year?__________________________________

E. QUALITY CONTROL DATA

1. Does your firm have a Standard Operating Procedure for Quality Control? Yes ___ No ____

2. Does your firm have a policy letter dealing with Quality Control? Yes _____ No _____

3. If not, how do you ensure quality? ________________________________________________

F. EXPERIENCE DATA & REFERENCES

List relevant current or past projects for your business for the past 3 years. Use additional sheets if needed.

1a. Project Name and Location: ________________________________________________

1b. Contract Amount: $____________________ Completion Date: ___________________

1c. Description of Work: ______________________________________________________

1d. Reference Name and Company: ____________________________________________

Address: ___________________________________________________________

Telephone No. ___________________________________________________________

2a. Project Name and Location: ________________________________________________

2b. Contract Amount: $____________________ Completion Date: ___________________

2c. Description of Work: ______________________________________________________

2d. Reference Company Name: ________________________________________________

Address: ___________________________________________________________

3a. Project Name and Location: ________________________________________________

3b. Contract Amount: $____________________ Completion Date: ___________________

3c. Description of Work: ______________________________________________________

3d. Reference Company Name: ________________________________________________

Address: ___________________________________________________________

4a. Project Name and Location: ________________________________________________

4b. Contract Amount: $____________________ Completion Date: ___________________

4c. Description of Work: ______________________________________________________

4d. Reference Company Name: ________________________________________________

Address: ___________________________________________________________

5a. Project Name and Location: ________________________________________________

5b. Contract Amount: $____________________ Completion Date: ___________________

5c. Description of Work: ______________________________________________________

5d. Reference Company Name: ________________________________________________

Address: ___________________________________________________________

Credit References

COMPANY NAME/ADDRESS

POINT OF

CONTACT

Telephone

Number Type of Work

NAME, ADDRESS, AND TELEPHONE NUMBER

FOR MAJOR SUBCONTRACTORS PLANNED FOR THIS WORK

TYPE OF WORK

Experience of Principal Individuals with your Company

NAME

PRESENT

POSITION

Years’ Experience with your Firm Type of Duties

I. PAYMENTS

1. Partial or final payments made under the proposed contract will be issued in accordance with FAR 52.232-27 of the solicitation entitled Prompt Payment for Construction Contracts. For this reason, the Contractor must have either:

(a) Adequate capital in hand to purchase materials, meet weekly payrolls, and cover other job expenses, or

(b) Credit available from suppliers, banks, etc. for these purposes.

2. Please complete the following: I have adequate financial resources in hand to pay for:

(a) Materials __________ (b) Labor __________

(c) Other job expenses _________

I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons names as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform contract work as described in the Request for Proposal.

Company Name of Offeror: ____________________________________________________

Printed Name of Signee:_______________________________________________________

Title of Signee:______________________________________________________________

Signature of Signee:__________________________________________________________