Attachment 3-Experience Questionnaire.pdf
PDF 140 KB Posted
- Attached to
- Dust Abatement-Magnesium Chloride Application
- Solicitation number
- 1240LS26Q0034
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a USDA Forest Service Experience Questionnaire template used to evaluate a contractor's qualifications and capability to perform a federal contract.
The questionnaire requires contractors to provide comprehensive information about their business background and relevant experience. Key sections include contractor identification and business type classification (company, corporation, co-partnership, individual, or non-profit organization); years of experience in the line of work and experience as prime or sub-contractors; a detailed listing of projects completed within the last three years with contract amounts, completion dates, and owner contact information; and current contractual commitments running concurrently with the proposed work, including contract numbers, dollar amounts, percentage completion, and contract completion dates. The form also requires contractors to disclose whether they have failed to complete awarded work, had work completed via performance bond, and whether they conducted on-the-ground site visits.
Additional sections address staffing and equipment resources, including minimum and maximum employee availability, payroll status, available equipment, and estimated progress rates. Contractors must list principal individuals involved in the proposed contract with their positions, years of experience, and relevant work experience. The form includes a remarks section for additional information supporting capability evaluation and concludes with a certification statement signed by an authorized official, attesting to the accuracy and completeness of all provided information and authorizing the Forest Service to verify referenced capabilities.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 3 USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.
1. Contractor Name, Address, and Telephone Number
2. Submitted to (Office Name and Address)
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 experience 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
Type of Project Date Completed
Name, Address, and Telephone No. 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:
Number
Dollar Amt.
of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date
Complete
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. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (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. (Who will directly be involved in this contract?)
Individual’s Name Present Position Years of Experience
Magnitude and Type of Work
11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO
SUCCESSFULLY COMPLETE THIS PROJECT.
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
b. SIGNATURE (Sign in ink) 13. DATE
File details come from the government source that posted it. Updated .