Attachment 3_Questionnaire_Experience and Past Performance.pdf
PDF 175 KB Posted
- Solicitation number
- 1240LP22Q0060
- Issued by
-
Department of Agriculture Forest Service
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 2 Wage Determination.pdf | ||
| 1240LP22Q0060 Solicitation Pkg.pdf | ||
| Attachment 1_Contract_Maps.pdf |
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Experience Questionnaire
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, Telephone Number, and Email Address:
2. SUBMITTED TO (Office Name and Address) Nebraska National Forest and Grasslands 1020 N. Deadwood Street Fort Pierre, SD 57532 ATTN: Catherine A Sullivan, Contract Specialist
3. COMPANY INFORMATION
DUNS or UEI: __________________ Small Business: Y/N
Primary NAICS Code: _____________
4. How many years of experience do you or your firm have in the line of work contemplated by this solicitation?
5. What is your experience working with GPS device and GIS software, for example, ESRI ArcMap?
6. Do you currently hold a South Dakota Applicator License? Y/N
7. Past Performance - List below the projects your business has completed within the last five (5) years which are similar in scope and scale to this job:
Contract Number
Contract Amount
Date Completed Names, Telephone No., and Email of Owner/Person to contact for Project Information
Description of Project
8. List below all of your firm's contractual commitments running concurrently with the work contemplated by this solicitation:
Contract # Dollar Amount
Name, Tel, Email of Business/Govt Agency Involved
Awarded (units) Percent Complete
Date Contract Completed
9a. Have you ever failed to complete any work awarded to you? Y/N
9b. If yes, please explain.
10. Organization and work that will be available for this project:
a. (1) Minimum number of employees: ______ and (2) Maximum number of employees:________
11. List below the experience of the key personnel who will be performing the work:
Individual’s Name Present Position Years of Experience
Magnitude and Type of Work
12. Remarks – Specify Box Numbers (Attach sheets if extra space is needed to fully answer any of the above questions.
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 Government with any information needed to verify my capability to perform this project.
13a. CERTIFYING OFFICIAL'S NAME AND TITLE
13b. SIGNATURE 14. DATE
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