ATT 7 - EXPERIENCE QUESTIONNAIRE 22R0016.docx
DOCX document 36 KB Posted
- Solicitation number
- 127EAW22R0016
- 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, past performance and available resources for a road reconstruction project on the Plumas National Forest. Key information includes the contractor's name, address, years of experience in road construction and contracting, a list of at least five relevant past projects with owner references, current contractual commitments, equipment available, and experience of principal staff. The related federal contract opportunity is a Request for Proposal to reconstruct Antelope Lake Road on the Plumas National Forest. The total small business set-aside opportunity is valued over $10 million, with proposals due by February 24, 2022. The RFP and seven attachments provide instructions for bid and technical proposal submission and a site visit. All requests for information must be submitted to the Contracting Officer by the same date.
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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 7 – Experience Questionnaire Evaluation Factor 1 RFP no. 127EAW22R0016 Antelope Lake Road Construction
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 .