Atch_4_Experience_Questionnaire.xls
XLS spreadsheet 31 KB Posted
- Solicitation number
- 140P6326Q0020
About this file
This is an Experience Questionnaire template required for contractor submission to the National Park Service. The form requests comprehensive information about the contractor's qualifications, experience, and capability to perform work on the Nicodemus National Historic Site Refinish Township Hall Flooring project (Solicitation 140P6326Q0020), issued by the Department of the Interior National Park Service Midwest Region.
The questionnaire collects critical contractor information including business type and structure, relevant years of experience in the specific line of work and as a prime contractor, and detailed project history from the past three years with contract amounts, project types, completion dates, and reference contacts. Contractors must disclose all current contract commitments with award amounts, completion percentages, and expected completion dates. The form requires disclosure of any work failures or performance bond completions with specific explanations of circumstances. Contractors must provide organizational staffing details including minimum and maximum employee availability, payroll status, and equipment resources available for the project. The form requests identification of principal individuals who will work on the project, including their names, positions, years of experience, and work types. Financial responsibility documentation is required either through submission of the completed financial information section or through a letter from a financial institution addressing account status and standing. The certification section requires the contractor to attest that all statements are complete and correct to the best of their knowledge and that named references are authorized to verify their capability to perform the work. The form may be completed manually or electronically using Microsoft Excel.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140P6326Q0020_Amd_0002.pdf | ||
| Amd_0002_Atch_1_Questions-Answers_0002.pdf | ||
| Sol_140P6326Q0020_Amd_0001.pdf | ||
| Sol_140P6326Q0020.pdf | ||
| Atch_3_Price_Schedule.xlsx | XLSX spreadsheet | |
| Atch_2_DOL_Wage_Determination_KS20260044_5_18_26.pdf | ||
| Atch_1_SOW.pdf |
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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
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