Attachment 3 - Experience and Equipment Questionnaire.pdf

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Attached to
Janitorial/Custodial & Related Services for USDA RD, Atoka, Oklahoma
Solicitation number
12RADZ22Q0002
Issued by

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A8.12 - Attachment 7 - Offeror Questions and Answers.xlsx XLSX spreadsheet
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Attachment 3 – Experience & Equipment Questionnaire Page 1 of 2

EXPERIENCE & EQUIPMENT QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.

EXPERIENCE

2. How many years do you or your firm have in the line of work contemplated by this solicitation?

3. BUSINESS

Company Co-partnership Corporation Individual Non-profit Organization

4. How many years of experience in contracting have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____

5. List below all Janitorial Services 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

6. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

CONTRACT

NUMBER

DOLLAR

AMOUNT OF

AWARD

NAME, ADDRESS & PHONE NUMBER OF

AGENCY INVOLVED

AWARDED

(Units)

PERCENT

COMPLETED

DATE

COMPLETED

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: (Attach separate sheet of paper if applicable)

Attachment 3 – Experience & Equipment Questionnaire Page 2 of 2

EQUIPMENT

8. Number of employees 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

9. List all the equipment you plan to use for this project.

10. List below the experience of employees intended to be used on this project:

INDIVIDUAL’S NAME

PRESENT

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

11. Did the offeror examine the area(s) for which this quote has been submitted? Yes No

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 USDA Rural Development with any information needed to verify my capability to perform this project.

Signature

Date

1 CONTRACTOR NAME ADDRESS AND TELEPHONE NO:
2 How many years do you or your firm have in the line of work contemplated by this solicitation:
Company: Off
Corporation: Off
Nonprofit Organization: Off
Copartnership: Off
Individual: Off
a a prime contractor:
contractor:
CONTRACT AMOUNTRow1:
TYPE OF PROJECTRow1:
DATE COMPLETEDRow1:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow1:
CONTRACT AMOUNTRow2:
TYPE OF PROJECTRow2:
DATE COMPLETEDRow2:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow2:
CONTRACT AMOUNTRow3:
TYPE OF PROJECTRow3:
DATE COMPLETEDRow3:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow3:
CONTRACT AMOUNTRow4:
TYPE OF PROJECTRow4:
DATE COMPLETEDRow4:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow4:
CONTRACT AMOUNTRow5:
TYPE OF PROJECTRow5:
DATE COMPLETEDRow5:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow5:
CONTRACT AMOUNTRow6:
TYPE OF PROJECTRow6:
DATE COMPLETEDRow6:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow6:
CONTRACT AMOUNTRow7:
TYPE OF PROJECTRow7:
DATE COMPLETEDRow7:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow7:
CONTRACT AMOUNTRow8:
TYPE OF PROJECTRow8:
DATE COMPLETEDRow8:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow8:
CONTRACT NUMBERRow1:
DOLLAR AMOUNT OF AWARDRow1:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow1:
AWARDED UnitsRow1:
PERCENT COMPLETEDRow1:
DATE COMPLETEDRow1_2:
CONTRACT NUMBERRow2:
DOLLAR AMOUNT OF AWARDRow2:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow2:
AWARDED UnitsRow2:
PERCENT COMPLETEDRow2:
DATE COMPLETEDRow2_2:
CONTRACT NUMBERRow3:
DOLLAR AMOUNT OF AWARDRow3:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow3:
AWARDED UnitsRow3:
PERCENT COMPLETEDRow3:
DATE COMPLETEDRow3_2:
CONTRACT NUMBERRow4:
DOLLAR AMOUNT OF AWARDRow4:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow4:
AWARDED UnitsRow4:
PERCENT COMPLETEDRow4:
DATE COMPLETEDRow4_2:
CONTRACT NUMBERRow5:
DOLLAR AMOUNT OF AWARDRow5:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow5:
AWARDED UnitsRow5:
PERCENT COMPLETEDRow5:
DATE COMPLETEDRow5_2:
CONTRACT NUMBERRow6:
DOLLAR AMOUNT OF AWARDRow6:
NAME ADDRESS PHONE NUMBER OF AGENCY INVOLVEDRow6:
AWARDED UnitsRow6:
PERCENT COMPLETEDRow6:
DATE COMPLETEDRow6_2:
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 locations and reasons why Attach separate sheet of paper if applicableRow1:
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 locations and reasons why Attach separate sheet of paper if applicableRow2:
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 locations and reasons why Attach separate sheet of paper if applicableRow3:
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 locations and reasons why Attach separate sheet of paper if applicableRow4:
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 locations and reasons why Attach separate sheet of paper if applicableRow5:
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 locations and reasons why Attach separate sheet of paper if applicableRow6:
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 locations and reasons why Attach separate sheet of paper if applicableRow7:
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 locations and reasons why Attach separate sheet of paper if applicableRow8:
Minimum number of employees:
and Maximum number of employees:
Are employees regularly on your payroll: Off
9 List all the equipment you plan to use for this project:
INDIVIDUALS NAMERow1:
PRESENT POSITIONRow1:
YEARS OF EXPRow1:
MAGNITUDE AND TYPE OF WORKRow1:
INDIVIDUALS NAMERow2:
PRESENT POSITIONRow2:
YEARS OF EXPRow2:
MAGNITUDE AND TYPE OF WORKRow2:
INDIVIDUALS NAMERow3:
PRESENT POSITIONRow3:
YEARS OF EXPRow3:
MAGNITUDE AND TYPE OF WORKRow3:
INDIVIDUALS NAMERow4:
PRESENT POSITIONRow4:
YEARS OF EXPRow4:
MAGNITUDE AND TYPE OF WORKRow4:
INDIVIDUALS NAMERow5:
PRESENT POSITIONRow5:
YEARS OF EXPRow5:
MAGNITUDE AND TYPE OF WORKRow5:
INDIVIDUALS NAMERow6:
PRESENT POSITIONRow6:
YEARS OF EXPRow6:
MAGNITUDE AND TYPE OF WORKRow6:
INDIVIDUALS NAMERow7:
PRESENT POSITIONRow7:
YEARS OF EXPRow7:
MAGNITUDE AND TYPE OF WORKRow7:
undefined_2: Off
undefined_3: Off
Text1:
7c If Yes to either item 7a or 7b specify locations and reasons why Attach separate sheet of paper if applicable: Off
undefined: Off

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