Attachment 2 Experience Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 1284LM25Q0050
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is an Experience Questionnaire for a USDA Forest Service contract opportunity for EMS and IMS Medical Direction Services. The form requires potential contractors to provide detailed information about their business experience, including years in the relevant work, past project completions, current contractual commitments, employee capacity, and key personnel qualifications. The questionnaire seeks comprehensive documentation of a contractor's capabilities, including business type, past performance, employee availability, and equipment resources.
Key details include the solicitation's focus on professional Emergency Medical Service (EMS) Medical Direction for Forest Service providers in Region 1, covering both regular EMS providers and Incident Medical Specialist (IMS) program employees. The solicitation allows for multiple firm-fixed-price awards, with contractors able to submit pricing for one or both project types (EMS or IMS). Contractors must provide pricing for all associated option line items, and questions about the solicitation should be emailed to joanne.meiers@usda.gov by June 30, 2025. The contract involves supporting emergency medical services for employees in various natural resource career fields, including wildland fire, recreation, range, fisheries, engineering, timber, and law enforcement.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SF-30 AMD 0002.pdf | ||
| AMD 0002 Questions and Answers.docx | DOCX document | |
| 1284LM25Q0050 AMD 0001.docx | DOCX document | |
| Attachment 1 Amended Statement of Work.docx | DOCX document | |
| SF-30 AMD 0001.pdf | ||
| 1284LM25Q0050.docx | DOCX document | |
| Attachment 1 Statement of Work.docx | DOCX document |
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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:
| Contract Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded (Units) |
| Percent Completed |
| Date Contract 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:______________________________________________________
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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