Attachment 3- ExpQ.pdf
PDF 37 KB Posted
- Attached to
- GMUG Grand Valley RD Vault Toilet Pumping
- Solicitation number
- 1240LP26Q0069
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for solicited work.
The form requires contractors to provide comprehensive background information including business structure, years of experience in the relevant line of work, and experience as prime and sub-contractors. Contractors must list projects completed within the last three years with contract amounts, completion dates, and owner contact information. The form also requires disclosure of all concurrent contractual commitments, including contract numbers, dollar amounts, units awarded, percent completed, and completion dates. Section 8 addresses performance history, specifically whether the contractor has failed to complete awarded work, had work completed via performance bond, and whether the contractor conducted on-the-ground site inspection. Section 9 requests detailed information about available resources, including minimum and maximum employee counts, payroll status, equipment specifications, and estimated progress rates. Section 10 requires listing principal individuals directly involved in the contract, including their positions, years of experience, and work magnitude and type. The form concludes with a certification section requiring the certifying official's signature and date. Contractors are permitted to attach additional sheets to Box 11 (Remarks) to provide supplementary information demonstrating capability to complete the project successfully.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1240LP26Q0069.pdf | ||
| Attachment 1 Statement of Work.pdf | ||
| Attachment 4 Wage Determination 15-5423 Mesa County.txt | TXT text file | |
| Attachment 2 Schedule of Items Grand Valley Pumping.pdf |
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
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 .