ATT 4 Experience Questionairre.pdf
PDF 138 KB Posted
- Attached to
- Fertilization Services at Ninemile Ranger District Federal contract opportunity
- Solicitation number
- 1284LM26Q0033
- Issued by
- Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications and capability to perform contract work.
The questionnaire requires contractors to provide comprehensive information about their business, experience, and resources. Key submission items include contractor name and contact information, business entity type (company, corporation, co-partnership, individual, or non-profit organization), years of experience in the relevant line of work, and years of experience as prime and sub-contractors. Contractors must list all projects completed within the past three years with contract amounts, project types, completion dates, and owner contact information for reference verification. Section 7 requires documentation of all concurrent contractual commitments, including contract numbers, award amounts, contracting parties, units awarded, percent completion, and expected completion dates. Sections 8a through 8d address project performance history, specifically whether the contractor has failed to complete awarded work, required performance bonds for project completion, and whether the contractor conducted on-site inspections. Section 9 addresses available resources, requiring specification of minimum and maximum employee counts, payroll status, equipment availability, and estimated minimum and maximum progress rates (measured in metrics such as acres per man-day). Section 10 requires listing principal individuals directly involved in the contract with their positions, years of experience, and magnitude and type of work performed. The form includes a certification statement requiring the certifying official to attest to the accuracy and completeness of all provided information and authorize reference checks. Section 11 provides space for remarks and additional information supporting the contractor's capability to successfully complete the project.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| ATT 2 Ninemile Administrative Pastures Map.pdf | ||
| ATT 3 Wage Determinations.pdf | ||
| ATT 1 Statement of Work.pdf | ||
| 1284LM26Q0033.pdf |
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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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