ATTACHMENT 4 Experience Questionaire.docx
DOCX document 68 KB Posted
- Attached to
- Reverse Osmosis Water System Maintenance Federal contract opportunity
- Solicitation number
- 12445024Q0004
- Issued by
- Department of Agriculture Forest Service
About this file
This Experience Questionnaire requests information from contractors interested in the Reverse Osmosis Water System Maintenance solicitation from the Department of Agriculture Forest Service. The solicitation seeks maintenance services for a reverse osmosis water system, as contractors are asked to provide details on their experience installing and servicing similar water treatment systems over the past three years. Contractors must disclose organizational information like employee counts, available equipment, and estimated progress rates. References from previous government and commercial clients are also requested, along with banking and credit details to facilitate a responsibility determination for the apparent successful offeror.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 3 Statement of Work 11.22.2023.pdf | ||
| ATTACHMENT 2 Wage Determination 2015-5161 Rev 24 07.14.2023.pdf | ||
| ATTACHMENT 1 Pricing Abstract 11.22.2023.xlsx | XLSX spreadsheet | |
| 12445024Q0004_Reverse-Osmosis_Water_System_Maintenance.pdf |
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Text version
Solicitation No: 12445024Q0004 Stoneville Reverse Osmosis System Attachment 4
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
| 1. Contractors Name, Address & Telephone No. Email | |
| 2. Type of Business | |
| Company | Co-Partner Non-profit |
Corporation Individual
| 3. How many years of experience do you have in this line of work | Yrs |
| 4. How many years of experience as a prime contractor | subcontractor |
5. List no more than 3 most relevant projects your business has performed within 3 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION. |
| DATE |
CONTRACT
COMPLETED
DESCRIPTION OF WORK PERFORMED
6. List all of your firms current contract commitments CONTRACTNAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION.
PERCENT
AWARD AMOUNT
NUMBER
| 7a. Have you ever failed to complete any work awarded to you? | yes | no |
| 7b. Has work ever been completed by performance bond? | yes | no |
7c. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: yes no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
b. Banking Information.
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
11. REMARKS
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:
| Name: |
| Title: |
| Date: |
File details come from the government source that posted it. Updated .