Attachment 2 Experience Questionnaire.pdf
PDF 114 KB Posted
- Solicitation number
- 1240LN25Q0004
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is an Experience Questionnaire from the USDA Forest Service designed to collect detailed information from potential contractors for the Vault Toilet Pumping Services contract on the Madison Ranger District. The two-page form requires contractors to provide comprehensive details about their business, including years of experience, previous project history, organizational capacity, available equipment, and key personnel qualifications. Contractors must specify their business type (company, corporation, etc.), years of contracting experience as prime or sub-contractors, and complete a detailed table listing projects similar to the current solicitation.
Key sections require respondents to disclose their minimum and maximum employee numbers, equipment availability, and provide a certification of the information's accuracy. The questionnaire also asks contractors to confirm whether they have ever failed to complete work or had work completed via performance bond. This document serves as a critical pre-qualification tool for the Forest Service to assess a contractor's capability to perform vault toilet pumping services under the anticipated Indefinite Delivery/Indefinite Quantity (IDIQ) contract, which has a base period and four potential option periods running from 06/05/2025 to 12/31/2029.
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Text version
USDA Forest Service (1/00)
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, Address, Telephone Number, and Email
2. Submitted to (Office Name & 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 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 three years (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount
Type of Project Ongoing or
Date Completed
Name, Address, and Telephone No.
of Owner/Person to Contact for
Project 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” to either item 7a or 7b specify location(s) and reason(s) why:
8. 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
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
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