Attachment 3 Experience Questionnaire.pdf
PDF 178 KB Posted
- Attached to
- Sawmill Liebre Reforestation Project Area Federal contract opportunity
- Solicitation number
- 127EAT25Q0011
- Issued by
- Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form (FS-6300-27) from the USDA Forest Service for contractors to detail their qualifications and past performance. The form is specifically for the Tujunga Ranger District of the Angeles National Forest and must be submitted to Contracting Officer Megan Acord.
The questionnaire requires contractors to provide comprehensive information including: business type (company, corporation, partnership, individual, or non-profit), years of experience in relevant work, prime/subcontractor experience, completed projects from the last three years, current contractual commitments, history of failed completions or performance bonds, organizational capacity (employee numbers and equipment), principal personnel experience, and self-inspection procedures. The form includes specific sections for listing past project details (contract amounts, descriptions, completion dates, and references), current contracts (with dollar amounts, award dates, and completion percentages), and available equipment with maintenance plans. The contractor must certify all information as complete and correct under signature.
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Text version
United States Department of Agriculture
Forest Service
CSA3– Region 5
Tujunga Ranger District Angeles National Forest
Procurement and Property Services
1400 Independence Ave, SW
MS-1138
Washington, DC 20250
Previous edition is obsolete Page 1 of 3 FS-6300-27 (3/00)
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.
2. SUBMITTED TO (office Name and Address)
USDA Forest Service Attn: Megan Acord, Contracting Officer Email: megan.acord@usda.gov
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 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 years:
CONTRACT
AMOUNT
(6a)
TYPE OF PROJECT AND BRIEF DESCRIPTION
(6b)
DATE
COMPLETED
(6c)
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
(6d) mailto:megan.acord@usda.gov
Agriculture
Forest
Angeles National Forest
Procurement and Property Services
1400 Independence Ave, SW
Previous edition is obsolete Page 2 of 3 FS-6300-27 (3/00)
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
CONTRACT
NUMBER
(7a)
DOLLAR AMT.
OF AWARD
(7b)
NAME, ADDRESS, AND TELEPHONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
(7c)
AWARDED
(Date) (7d)
PERCENT
COMPLETED
(7e)
ANTICIPATED
COMPLETE DATE
(7f)
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: Yes No 8d. Did you look at the project site(s) on-the-ground? Yes No
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
(10a)
PRESENT
POSITION
(10b)
YEARS
OF EXP.
(10c)
MAGNITUDE AND TYPE OF WORK
(10d)
11. List all the equipment you own or have available through a rental agreement to be used on this contract/agreement. Provide a detailed description of the Equipment including your maintenance and cleaning plans.
Agriculture
Forest
Angeles National Forest
Procurement and Property Services
1400 Independence Ave, SW
Previous edition is obsolete Page 3 of 3 FS-6300-27 (3/00)
12. Contractor Inspection. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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
14b. SIGNATURE (Sign in ink) 14c. DATE
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