ATT 5 EXPERIENCE QUESTIONNAIRE 22R0008.docx
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- Solicitation number
- 127EAW22R0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This Experience Questionnaire is a template for contractors to provide details about their qualifications, experience, capacity and past performance for a USDA Forest Service road construction and bridge replacement project on the Sequoia National Forest in California. Key information includes: the solicitation is for road construction on Tenmile Road and replacement of the Hume Lake Bridge with a total value between $5-10 million and set aside for small businesses; contractors must demonstrate a minimum of 5 years experience in road construction and contracting; the submission deadline for Requests for Information is March 3, 2022; contractors must disclose their organizational details including equipment, employees, concurrent contracts, and bonding capacity; and references must be provided to verify the contractor's ability to successfully complete the project.
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Text version
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
| 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 of experience in contracting 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 five (5) 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:
| CONTRACT NUMBER |
| DOLLAR AMT. OF AWARD |
| NAME, ADDRESS, AND TELEPHONE NO. OF BUSINESS/GOVERNMENT AGENCY INVOLVED |
| AWARDED |
(Units)
| PERCENT COMPLETED |
| DATE |
CONTRACT COMPLETED
| 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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why: |
Previous edition is obsolete (OVER)
FS-6300-27 (3/00)
ATTACHMENT 5 – Experience Questionnaire Evaluation Factor 1 RFP no. 127EAW22R0008
9. Organization and work that will be available for this project.
| a. (1) Minimum number of employees: | and a (2) Maximum number of employees: | ? |
| b. Are employees regularly on your payroll: Yes | No’ |
c. Specify equipment available for this contract
10. List below the experience of the principal individuals of your business:
| INDIVIDUAL’S NAME |
| PRESENT POSITION |
| YEARS OF EXP. |
| MAGNITUDE AND TYPE OF WORK |
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person’s name 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 |
(Use Additional Sheets As Needed) image1.png image2.png
File details come from the government source that posted it. Updated .