Atachment 3 ExpQ.pdf
PDF 37 KB Posted
- Attached to
- GMUG Ouray RD Vault Toilet Pumping
- Solicitation number
- 1240LP26Q0070
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor capability and qualifications for federal solicitations.
The form requires contractors to provide comprehensive information about their business qualifications, experience, and capacity to perform work. Key sections include: contractor identification and business type (company, corporation, co-partnership, individual, or non-profit); years of experience in the relevant line of work as both prime and sub-contractors; a detailed list of projects completed within the last three years with contract amounts, completion dates, and owner contact information; and all current contractual commitments running concurrently with the proposed work, including contract numbers, dollar amounts, percentage completion, and completion dates. The form also requires disclosure of any failed work completions or instances where work was completed by performance bond, along with explanations for such occurrences. Additionally, contractors must confirm whether they conducted on-the-ground site inspections.
The form requests information on available resources, including minimum and maximum employee counts, confirmation of regular payroll status, specific equipment available for the contract, and estimated progress rates. Contractors must provide detailed information about principal individuals directly involved in contract performance, including their names, titles, years of experience, and the magnitude and type of work they will oversee. A certification section requires the certifying official to sign and date the form, confirming the accuracy and completeness of all statements provided. The form permits additional remarks and supporting documentation in a designated section to address any questions or provide supplementary information relevant to evaluating the contractor's ability to successfully complete the project.
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Text version
USDA Forest Service
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 and Address)
3. Business [ ] Company [ ] Co-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 have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
Contract Amount
Type of Project Date Completed
Name, Address, and Telephone No. of Owner/Person to Contact for Project Information
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
Number
Dollar Amt.
of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date
Complete
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. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:______________________________________________________
d. Estimate rate of progress below (such as 2.0 acres/man/day):
(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________
10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)
Individual’s Name Present Position Years of Experience
Magnitude and Type of Work
11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO
SUCCESSFULLY COMPLETE THIS PROJECT.
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
b. SIGNATURE (Sign in ink) 13. DATE
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