Atch_3_Experience_Questionaire.xls
XLS spreadsheet 37 KB Posted
- Attached to
- AGFO BPA PROPANE
- Solicitation number
- 140P6324Q0073
About this file
This document is an Experience Questionnaire that is part of a federal contract opportunity for Propane Deliveries at Agate Fossil Beds National Monument. The key details are:
The contract opportunity is for a Blanket Purchase Agreement (BPA) for propane delivery services. The contracting agency is the National Park Service Midwest Region. The solicitation number is 140P6324Q0073. The questionnaire requests information about the contractor's business, experience, personnel, equipment, and financial responsibility. Specific details requested include years of experience, prior contracts completed, current contract commitments, employee and equipment resources, and financial institution information. The contractor must certify their intent to complete the project as specified. This questionnaire appears to be used to evaluate the contractor's capability to perform the required services.
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Other files
| File | Type | Posted |
|---|---|---|
| Atch_1_SOW.pdf | ||
| Sol_140P6324Q0073.pdf | ||
| Atch_2_Price_Schedule.docx | DOCX document |
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Text version
Sheet1
| 1. Contractors Name, Address, & Telephone No.: | 2. Type of Business | ||||||
| Name: | |||||||
| Address: | Company | ||||||
| Corporation | |||||||
| Non-profit Org | |||||||
| Telephone No.: | Co-partner | ||||||
| SAM DUNS No: | Individual | ||||||
| 3. How many years experience do you have in this line of work? | Years | ||||||
| 4. How many years experience as a prime contractor? | Years | ||||||
| 5. List the contracts your business has completed for Propane Deliveries in the last 3 years: | |||||||
| CONTRACT | |||||||
| AMOUNT | TYPE OF | ||||||
| PROJECT | DATE | ||||||
| COMPLETED | NAME, ADDRESS & TELEPHONE NO.TO |
CONTACT FOR INFORMATION
| 6. List all of your firms current contract commitments: | |||||
| CONTRACT | |||||
| NUMBER | AWARD | ||||
| AMOUNT | NAME, ADDRESS, & PHONE NO. | ||||
| TO CONTACT FOR INFORMATION | PERCENT | ||||
| COMPLETED | DATE |
COMPLETED
| 7a. Have you ever failed to complete any work awarded to you? | Yes | No | ||||||||||||
| 7b. Has work ever been completed by performance bond? | Yes | No | ||||||||||||
| 7c. If "Yes" to either item 7a or 7b, specify locations and reason why: | ||||||||||||||
| 8. Organization that will be available for this project: | ||||||||||||||
| a. Minimum No. of employees: | and maximum No. of employees: | |||||||||||||
| b. Are employees regularly on your payroll? | Yes | No | ||||||||||||
| c. Specify equipment available for this project: | ||||||||||||||
| 9. List the experience of principal individuals with proper qualifications/certifications to be used on this project: | ||||||||||||||
| INDIVIDUALS | ||||||||||||||
| NAME | PRESENT | |||||||||||||
| POSITION | YEARS | |||||||||||||
| EXPERIENCE | TYPE OF WORK | |||||||||||||
| 10. Financial Responsibility: | ||||||||||||||
| (in lieu of this, you may submit a letter from your | ||||||||||||||
| financial institution that addresses the status and standing of your accounts) | ||||||||||||||
| Name of Financial Institution | ||||||||||||||
| Address: | ||||||||||||||
| Contact Name | ||||||||||||||
| Contact Phone Nbr | ||||||||||||||
| 11. Remarks | ||||||||||||||
| CERTIFICATION: I certify that I intend to complete the project as specified and that my offer conforms to the specifications of the solicitation without deviation unless I provide an alternative proposal. All 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 National Park Service with any information needed to verify my capability to perform this project. | ||||||||||||||
| SIGNATURE | TITLE | DATE |
EXPERIENCE QUESTIONNAIRE
Instructions: This form may be completed manually or by using MS Excel. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
File details come from the government source that posted it. Updated .