Attachment_4_QUESTIONAIRE.docx

PROPOSAL SUBMISSION QUESTIONAIRE – AG-82A7-S-16-0070

☐ Completed Schedule of Items (Section B) with proposed pricing for the base bid item and ALL optional bid items (If applicable)

☐ Offeror confirms the attached Scope of Work, Special Project Specifications and Drawings have been thoroughly reviewed before submitting a proposal.

☐ The registration process at www.SAM.gov has been successfully completed.

☐ Offeror confirms the provision FAR 52.204-8, the annual representations and certifications, has been electronically completed at www.SAM.gov. The complete provision can be found at https://www.acquisition.gov/far/loadmainre.html.

☐ Contractor DUNS number is provided:_________________________

☐ SF-1442 and all amendments (if applicable) submitted

☐ Statement regarding use of Bio-Based Products (see below)

Proof of General Insurance, in accordance with FAR 52.228-5;

☐ IS provided (1 page allowed each) OR ☐ CAN be provided before contract award.

Contractor’s Point of Contact (POC) Information is provided:

Name/Position: Email:

Phone: Fax:

☐ The following questions have been answered as provided below (1 additional page allowed, if necessary):

1. Do you have any other Job Corp/Federal Government experience? If so, where?

1. Within the past 5 years have you failed to complete any work awarded to you or been terminated for default or breach of contract? If yes, explain.

1. How many years of experience do your company and any key personnel have in regards to the requirements stated in this Invitation for Bid?

1. Are technical factors addressed (Installer Qualifications and Proposed Schedule.

5. As required by the USDA - this requirement includes the use of BioBased Products, as identified in Section C.9 of the Scope of Work– please state how this will apply to this requirement, including list of products if applicable. If nothing will be used, please provide a statement as to why.

☐ The following three (3) professional references of similar past work performance is provided:

1. Name: Organization:

Phone: Email:______________________________________

1. Name: Organization:

Phone: Email:______________________________________

1. Name: Organization:

Phone: Email:

☐ I certify that all of the information provided above is complete, true, and correct to the best of my knowledge.

Sign:______________________________________ Date:_______________________________________