Att 5 Past Performance_Experience_Questionnaire.pdf

PDF 238 KB Posted Apr 24, 2025

Attached to: Groundskeeping Service (Lawn Mowing and Weed Trimming)-Tombigbee RD, Mississipi
Solicitation number: 12444225Q0018
Issued by: Department of Agriculture Forest Service

About this file

Written by GovTribe AI · Apr 24, 2025

The document is an Experience and Past Performance Questionnaire for a groundskeeping services contract with the U.S. Forest Service for the Tombigbee Ranger District in Mississippi. The form requires detailed information from potential contractors, including business type, years of experience, previous project history, current contract commitments, organizational capacity, safety plans, and site visit observations. Key requirements include being a small business (NAICS code 561730, size standard $9.5M), providing groundskeeping services for the Tombigbee Ranger District office in Ackerman, MS, and submitting quotes by 5:00 PM Central Time on May 9, 2025. Contractors must complete the questionnaire, which solicits information about their workforce, equipment, project experience, safety protocols, and capability to perform the required services.

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Other files

File	Type	Posted
Att 2- Wage Determination 2015-5157 MS.pdf	PDF	Apr 24, 2025
Att 1-Performance Work Statement_Tombigbee RD.pdf	PDF	Apr 24, 2025
Att 3-Maps.pdf	PDF	Apr 24, 2025
Combined Synopsis Solicitation 12444225Q0018.pdf	PDF	Apr 24, 2025
Att 4 -Schedule of Items.xlsx	XLSX spreadsheet	Apr 24, 2025

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Experience and Past Performance Questionnaire

Instructions: See Box 10, Remarks, if extra space is needed to answer any item below.

Mark X in the appropriate boxes.

1. Contractors Name, Address, & Telephone No. 2. Type of Business:

Company Co-Partner

Corporation Individual

Non-profit Organization

3. How many years experience do you have in this line of work? Years

4. How many years experience as a prime contractor? As a subcontractor?

5. Attach a list or 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

Percent Completion

Date Contract Completed

Name, Address, & Telephone no. to Contact for Information.

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’ was checked to either item 7a or 7b, specifiy location(s) and reason(s) why:

Phone #:

8. Organization that will be available for this project:

a. Minimum number of employees: and 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 (Such as acres/day, miles/day, or other rate):

Minimum progress rate: Maximum progress rate:

9. List the experience of the principal individuals of your business:

Individuals Name Present Position Years of Experience Type of Work

12. SITE VISIT

12a. How extensive was your site visit for this project? (e.g., ‘didn’t visit;’ ‘drove by some areas;’ ‘walked each acre.’)

12b. What did the site visit reveal about the comparative difficulty of the project—e.g., the problems that are likely to be encountered during performance?

13. SAFETY

What is your plan for safety at the job site(s)? Identify the hazards specific to the site(s) and the types of work being performed and how you plan to mitigate the risks—to your workers, FS inspectors, and the public.

14. REMARKS/COMMENTS (if any)

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 capabilities to perform this project.

Printed Name Signature Title Date

Experience Questionnaire

Award

1 Contractors Name Address Telephone No:

Company:

CoPartner:

Corporation:

Individual:

Nonprofit Organization:

Years:

As a subcontractor:

undefined:

Contract AmountRow1:

Type of ProjectRow1:

Date CompletedRow1:

Name Address Telephone no to Contact for InformationRow1:

Contract AmountRow2:

Type of ProjectRow2:

Date CompletedRow2:

Name Address Telephone no to Contact for InformationRow2:

Contract AmountRow3:

Type of ProjectRow3:

Date CompletedRow3:

Name Address Telephone no to Contact for InformationRow3:

Contract AmountRow4:

Type of ProjectRow4:

Date CompletedRow4:

Name Address Telephone no to Contact for InformationRow4:

Contract AmountRow5:

Type of ProjectRow5:

Date CompletedRow5:

Name Address Telephone no to Contact for InformationRow5:

Contract AmountRow6:

Type of ProjectRow6:

Date CompletedRow6:

Name Address Telephone no to Contact for InformationRow6:

Contract AmountRow7:

Type of ProjectRow7:

Date CompletedRow7:

Name Address Telephone no to Contact for InformationRow7:

6 List all of your firms current contract commitments:

Contract NumberRow1:

Award AmountRow1:

Percent CompletionRow1:

Date Contract CompletedRow1:

Name Address Telephone no to Contact for InformationRow1_2:

Contract NumberRow2:

Award AmountRow2:

Percent CompletionRow2:

Date Contract CompletedRow2:

Name Address Telephone no to Contact for InformationRow2_2:

Contract NumberRow3:

Award AmountRow3:

Percent CompletionRow3:

Date Contract CompletedRow3:

Name Address Telephone no to Contact for InformationRow3_2:

Contract NumberRow4:

Award AmountRow4:

Percent CompletionRow4:

Date Contract CompletedRow4:

Name Address Telephone no to Contact for InformationRow4_2:

Contract NumberRow5:

Award AmountRow5:

Percent CompletionRow5:

Date Contract CompletedRow5:

Name Address Telephone no to Contact for InformationRow5_2:

Contract NumberRow6:

Award AmountRow6:

Percent CompletionRow6:

Date Contract CompletedRow6:

Name Address Telephone no to Contact for InformationRow6_2:

Contract NumberRow7:

Award AmountRow7:

Percent CompletionRow7:

Date Contract CompletedRow7:

Name Address Telephone no to Contact for InformationRow7_2:

Yes:

No:

Yes_2:

No_2:

a Minimum number of employees:

and Maximum number of employees:

b Are employees regularly on your payroll:

Yes_3:

c 1:

c 2:

d Estimate rate of progress Such as acresday milesday or other rate:

Minimum progress rate:

Maximum progress rate:

9 List the experience of the principal individuals of your business:

12a How extensive was your site visit for this project eg didnt visit drove by some areas walked each acreRow1:

12b What did the site visit reveal about the comparative difficulty of the projecteg the problems that are likely to be encountered during performanceRow1:

What is your plan for safety at the job sites Identify the hazards specific to the sites and the types of work being performed and how you plan to mitigate the risksto your workers FS inspectors and the publicRow1:

14 REMARKSCOMMENTS if anyRow1:

14 REMARKSCOMMENTS if anyRow2:

14 REMARKSCOMMENTS if anyRow3:

14 REMARKSCOMMENTS if anyRow4:

14 REMARKSCOMMENTS if anyRow5:

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 capabilities to perform this projectRow1:

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7c If Yes was checked to either item 7a or 7b specifiy locations and reasons why:

File details come from the government source that posted it. Updated Apr 24, 2025.