ATT 7 - EXPERIENCE QUESTIONNAIRE 22R0016.pdf
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- Solicitation number
- 127EAW22R0016
- Issued by
-
Department of Agriculture Forest Service
About this file
This Experience Questionnaire is a pre-qualification form for contractors interested in the Road Reconstruction, Antelope Lake Road project on the Plumas National Forest. The solicitation seeks bids for reconstructing Antelope Lake Road and has a total value over $10 million. Contractors must complete the Experience Questionnaire to be evaluated on past experience for Factor 1. The form requests information on the contractor's experience, current projects, personnel, and references. It must be signed and certified by an official of the bidding company. Any requests for information on the solicitation must be submitted to the Contracting Officer Jeremy Bedner by February 24, 2022. The final proposal is due on an unspecified future date per any amendments. The solicitation was published on February 2, 2022 by the USDA Forest Service Plumas National Forest for the road reconstruction project.
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Text version
ATTACHMENT 7 – Experience Questionnaire Evaluation Factor 1
RFP no. 127EAW22R0016 Antelope Lake Road Construction
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:
NUMBER
DOLLAR AMT.
OF AWARD
NAME, ADDRESS, AND TELEPHONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
AWARDED
(Units)
PERCENT
COMPLETED
DATE
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)
File details come from the government source that posted it. Updated .