Atch_4_Experience_Questionnaire.xls

XLS spreadsheet 31 KB Posted

Attached to
Nicodemus National Historic Site Refinish Township
Solicitation number
140P6326Q0020
Issued by

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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Sol_140P6326Q0020_Amd_0002.pdf PDF
Amd_0002_Atch_1_Questions-Answers_0002.pdf PDF
Sol_140P6326Q0020_Amd_0001.pdf PDF
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Atch_2_DOL_Wage_Determination_KS20260044_5_18_26.pdf PDF
Atch_1_SOW.pdf 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
AMOUNTTYPE OF
PROJECTDATE
COMPLETEDNAME, ADDRESS & TELEPHONE NO.TO

CONTACT FOR INFORMATION

6. List all of your firms current contract commitments:
CONTRACT
NUMBERAWARD
AMOUNTNAME, ADDRESS, & PHONE NO.
TO CONTACT FOR INFORMATIONPERCENT
COMPLETEDDATE

COMPLETED

7a. Have you ever failed to complete any work awarded to you?YesNo
7b. Has work ever been completed by performance bond?YesNo
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?YesNo
c. Specify equipment available for this project:
9. List the experience of principal individuals to be used on this project:
INDIVIDUALS
NAMEPRESENT
POSITIONYEARS
EXPERIENCETYPE 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.
NAMETITLEDATE

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 .