Attachment 3 - Experience Questionnaire.docx

Attachment 3 - Experience Questionnaire

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.

DUNS #: (please provide)

2. SUBMITTED TO (office Name and Address) Brian A. Johnson USDA Forest Service brian.johnson3@usda.gov

3. BUSINESS

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 three (3) years (2018-2019-2020):

CONTRACT AMOUNT

TYPE OF PROJECT

DATE COMPLETED

NAME, TELEPHONE NO., & E-MAIL ADDRESS

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

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Previous edition is obsolete (OVER) FS-6300-27 (3/00)

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. Provide a list all contractor-owned cleaning equipment you plan to use during performance of this contract.

12. Contractor Inspection. Describe Contractor Self-Inspection Procedures you will use to insure compliance with the "Work Standards" and "Quality Control" as required by the solicitation.

13. Due to the remote location of this Forest Service facility, please describe your company's familiarity with the project area and how your company's location will ensure success of this project over the next five (5) years.

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.

14a. CERTIFYING OFFICIAL’S NAME AND TITLE