Attachment 3 Experience Questionnaire.pdf
PDF 243 KB Posted
- Attached to
- Palomar RD Janitorial Service at CNF
- Solicitation number
- 127EAT25Q0037
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire (Form FS-6300-27) for a contract opportunity with the Cleveland National Forest, Region 5. The form is designed to collect detailed information about a potential contractor's business experience, past projects, current contractual commitments, organizational capacity, and capability to perform the proposed work. Key sections require the contractor to provide information about years of experience, previous completed projects, concurrent contract commitments, equipment availability, key personnel experience, and self-inspection procedures. The document includes spaces for the contractor to detail their business type, minimum and maximum employee counts, equipment resources, and a certification of the accuracy of the provided information. The questionnaire will be submitted to Fareedah Vaughn, Contract Specialist, and is intended to help the USDA Forest Service evaluate the contractor's qualifications for a specific solicitation.
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Text version
United States Department of Agriculture
Forest Service
CSA3– Region 5 Cleveland National Forest
Procurement and Property Services
USDA - FS CSA SW3, 333
Broadway Blvd SE, Albuquerque NM 87102-3498
Previous edition is obsolete Page 1 of 3 FS-6300-27 (3/00)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: Fareedah Vaughn Contract Specialist Email: fareedah.vaughn@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 FareedahVaughn Cross-Out
Agriculture
Forest Service
CSA3– Region 5 Cleveland National Forest
Procurement and Property Services
USDA - FS CSA SW3, 333
Broadway Blvd SE, Albuquerque NM 87102-3498
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 Service
CSA3– Region 5 Cleveland National Forest
Procurement and Property Services
USDA - FS CSA SW3, 333
Broadway Blvd SE, Albuquerque NM 87102-3498
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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