Attachment_3_and_4_MS_Word.doc
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- Attached to
- Drum Chopping IDIQ, Conecuh Ranger District Federal contract opportunity
- Solicitation number
- AG-4146-S-15-0006
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| 000001_AG-4146-S-15-0006.pdf | ||
| Complete_Solicitaiotn_AG-4146-S-15-0006.pdf |
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Drum Chopping IDIQ, Conecuh Ranger District
AG-4146-S-15-0006
Drum Chopping IDIQ, Conecuh Ranger District
AG-4146-S-15-0006
ATTACHMENT 3
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address & Telephone No.
2. Type of Business
__Company __Co-Partner __Non-profit
__Corporation __Individual
3. How many years of experience do you have in this line of work____ Years
4. How many years of experience as a prime contractor_____ subcontractor___
5. LIST OF PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST 5 YEARS
NOTE: Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, size , type of debris/vegetation), Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: _______________________________________________________________________
Contact Name and Telephone number: ___________________________________________________________________
Description of Services (refer to note in No. 5 above )(Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: _______________________________________________________________________
Contact Name and Telephone number: ___________________________________________________________________
Description of Services (refer to note in No. 5 above )(Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: _______________________________________________________________________
Contact Name and Telephone number: ___________________________________________________________________
Description of Services (refer to note in No. 5 above )(Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: _______________________________________________________________________
Contact Name and Telephone number: ___________________________________________________________________
Description of Services (refer to note in No. 5 above )(Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: _______________________________________________________________________
Contact Name and Telephone number: ___________________________________________________________________
Description of Services (refer to note in No. 5 above )(Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6b. Have you defaulted on any work? __yes __ no
6c. If "yes" to either item 6a or 6b specify location(s) and reason(s) why
7. List the experience of the primary individuals to perform on proposed project
| INDIVIDUALS NAME |
| PRESENT POSITION |
| DEGREE/YRS EXP |
| TYPE OF WORK |
8. REMARKS (Additional sheets may be attached to the experience questionnaire)
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: |
ATTACHMENT 4
PRESENT/PAST PERFORMANCE QUESTIONNAIRE
SECTION A: CONTRACTOR INFORMATION
A. Contractor’s Name and Address: ________________________________________________
B. Point of Contact: ______________________________________________________________
C. Phone #: ____________________________________________________________________
D. Contract Number: ______________________ Contract Type: ________________________
E. Project Title: _________________________________________________________________
F. Period of Performance: _________________________________________________________
G Description of Services (Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)
Use of only a project title does not usually provide enough detail to determine what work was performed.
H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire.
Signature of Authorized Contractor Representative Date
Printed Name and Title of Authorized Contractor Representative
RESPONDENT (CUSTOMER) INFORMATION:
A. Company Name : _______________________________________________________________
B. Name/Position of person completing questionnaire:_____________________________________
C. Telephone Number:_____________________________ Fax Number: _____________________
D. Address:_______________________________________________________________________
E. Relationship and Time Involved with Contractor:______________________________________
F. Date Questionnaire Completed:_______________________
| E |
| VG |
| S |
| N |
| M |
| U |
| Excellent |
| Very Good |
| Satisfactory |
| Neutral |
| Marginal |
| Unsatisfactory |
A. CONTRACT PERFORMANCE
| 1. |
| Working relationship with your Company? |
| E |
| VG |
| S |
| N |
| M |
| U |
| 2. |
| How well did the contractor provide experienced workers, managers and supervisors with the technical and administrative abilities needed? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 3. |
| Did the contractor exhibit knowledge of and compliance with government (or other) regulations and industry standards? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 4. |
| How well did the contractor provide and properly maintain operational equipment throughout the term of the contract? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 5. |
| Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 6. |
| How well did the contractor comply with Environmental, health, labor laws, safety and security requirements? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 7. |
| Contractor’s Overall Performance |
| E |
| VG |
| S |
| N |
| M |
| U |
B. QUALITY OF SERVICE/CONTROL
| 1. |
| Contractor’s accomplishment in meeting the quality standards |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 2. |
| The contractor provided an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain. |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 3. |
| Contractor identified and corrected deficient Work |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 4. |
| Contractor’s Overall Quality of Workmanship |
| E |
| VG |
| S |
| N |
| M |
| U |
TIMELINESS OF PERFORMANCE
| 1. |
| How well did the contractor comply with the contract schedule? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 2. |
| Did the contractor provide timely and accurate records, submittals, and/or reports? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
| 3. |
| How well did the contractor resolve any delays? |
| E |
| VG |
| S |
| N |
| M |
| U |
| N/A |
REMARKS: For ratings above or below satisfactory, please provide remarks to describe the reasons for the rating. If additional remarks are necessary, please attach an additional sheet._____________________________________________________________
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