Attachment 3 - Experience Questionnaire.doc

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Attached to
Helena-Lewis & Clark NF - Kading Campground Well Drilling
Solicitation number
1240LU26Q0069
Issued by

About this file

This is an Experience Questionnaire template used by the Forest Service to evaluate contractor qualifications for federal projects.

The questionnaire requires contractors to provide organizational capacity information including minimum and maximum employee counts, payroll status, and available equipment specifications. Contractors must document their rate of progress (measured in units such as acres per man-day) with both minimum and maximum estimates. The form requests detailed experience information for principal business individuals, including their names, current positions, years of experience, and descriptions of work magnitude and type. A certification section requires the authorized official to attest under penalty that all statements are complete and correct, and authorizes the Forest Service to contact listed references to verify capability to perform the project. The form includes space for additional remarks and requires the certifying official's signature, title, and date. This questionnaire is used in conjunction with solicitation 1240LU26Q0069 for Kading Campground Well Drilling services on the Helena-Lewis and Clark National Forest, which is a small business set-aside procurement for well drilling and hand pump installation work.

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Text version

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:_______________________________________________

d. Estimate rate of progress below (such as 2.0 acres/man/day):

(1) Minimum progress rate: __________ and (2) Maximum progress rate: __________

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

11. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):

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

File details come from the government source that posted it. Updated .