A12_Attch4_Proposal_Subm._Pkg..docx

SOLICITATION AG-82A7-S-17-0004: ATTACHMENT 4

PROPOSAL SUBMISSION PACKAGE

NOVEMBER 1, 2016

INSTRUCTIONS: The following forms may be used to prepare proposals for the subject solicitation as applicable.

CONTENTS:

For Technical Volume:

1. Experience Questionnaire

2. Past Performance Questionnaire

For Business & Price Volume:

3. Section B Price Schedule

4. General References

Experience Questionnaire READ CAREFULLY: The purpose of this form is for the offeror to list projects performed that are similar to the work described in this solicitation. Use this form to address your familiarity with the project requirements and with the evaluation criteria described in the solicitation. Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their experience may be considered by others to be less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s experience.

Name of Contractor/Offeror:

Project Location:

Name of Owner:

Address of Owner:

Telephone Number:

Project Value:

Dates of Construction:

Description of the Project and Scope of Offeror’s Work

Performance Remarks

Description of the Project and Scope of Offeror’s Work (continuation)

Performance Remarks (continuation)

PAST PERFORMANCE QUESTIONNAIRE

1. Information Provided in Response to Solicitation No.: AG-82A7-S-17-0004

2. Offeror:

PART I: Contract Information

3. Customer Organization:

4. Reference Name and Title: (individual completing this questionnaire)

5. Contract Number:

6. Contract Type:

7. Contract Value:

8. Description of Work/Services:

9. Problems: (if problems encountered on this contract, explain corrective action taken)

Part II: Performance Assessment (to be completed by reviewer)

1. Quality of product or service: (please double click on check box to check and uncheck box)

E |_| V |_| S |_| M |_| U |_| N |_|

Comment:

2. Schedule: (please double click on check box to check and uncheck box)

E |_| V |_| S |_| M |_| U |_| N |_|

Comment:

3. Management: (please double click on check box to check and uncheck box)

E |_| V |_| S |_| M |_| U |_| N |_|

Comment:

4. Regulatory Compliance: (please double click on check box to check and uncheck box)

E |_| V |_| S |_| M |_| U |_| N |_|

Comment:

WO AQM Job Corps Support Branch Contact Information:

Contracting Officer: Brian N. McCabe Contract Specialist: Sarah Pheral

OR EMAIL FORM TO: bmccabe@fs.fed.us and spheral@fs.fed.us

SECTION B PRICE SCHEDULE

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided. Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

Name of Contractor/Offeror:

Surety

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Insurance Company

Name:

Address:

Name of Agent:

Telephone Number:

Types of Policies:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Material Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

Material Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material: