Atch_3_Experience_Questionnaire.xls
XLS spreadsheet 31 KB Posted
- Attached to
- Theodore Roosevelt NP-Restripe Roads
- Solicitation number
- 140P6326Q0008
About this file
This is an Experience Questionnaire form used by the National Park Service to evaluate contractor qualifications for the Theodore Roosevelt NP-Restripe Roads project (Solicitation Number 140P6326Q0008). The form is a template designed to be completed manually or in MS Excel and serves as an appendix to the solicitation.
The questionnaire requires contractors to provide company information, business type, and years of experience in the relevant line of work and as prime contractors. Contractors must list projects completed in the last three years with contract amounts, project types, completion dates, and reference contacts, as well as current contract commitments including contract numbers, award amounts, and percent completion. The form also requires disclosure of any failed work completions or performance bond issues. Contractors must identify the minimum and maximum number of employees available for the project, confirm regular payroll status, specify equipment availability, and provide experience details for principal individuals assigned to the project. Financial responsibility information must be documented either directly through financial institution details or via a letter from the contractor's bank addressing account status and standing. The form includes a certification statement requiring the contractor to affirm the completeness and accuracy of all provided information and authorize the National Park Service to verify capability to perform the work.
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Other files
| File | Type | Posted |
|---|---|---|
| Atch_1_SOW.pdf | ||
| Sol_140P6326Q0008.pdf | ||
| Atch_4_DOL_Wage_Determination_ND20260001_1_30_26.pdf | ||
| Atch_2_Submittal_List.xls | XLS spreadsheet |
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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 | ||||||
| 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 projects your business has completed 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 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 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. | ||||||||||||||
| NAME | 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.
Sheet2
Sheet3
File details come from the government source that posted it. Updated .