Attachment 4 Experience Questionnaire ( 2 Pages).docx
DOCX document 72 KB Posted
- Solicitation number
- 12445025Q0020
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire attachment for a federal contract opportunity requiring contractors to provide detailed information about their qualifications and experience for lawn care services at the National Agroforestry Center in Lincoln, Nebraska.
The questionnaire requires contractors to provide comprehensive business information including company details, years of experience, type of business structure, and up to three relevant projects completed within three years of the solicitation date. Contractors must detail their organizational capacity including minimum and maximum employee counts, equipment availability, and estimated progress rates for lawn care work. The form also requires information about principal individuals' experience, credit references, banking information, and disclosure of any past performance issues including incomplete work or performance bond requirements. All information must be certified as complete and correct, and contractors must authorize their references to provide verification information to the Forest Service. This questionnaire is part of solicitation 12445025Q0020, a small business set-aside procurement with a NAICS code of 561730 for landscaping services, with quotes due by August 21st, 2025.
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Text version
Solicitation No: 12445025Q0020 National Agroforestry Center Lawn Services
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
| 1. Contractor’s 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 firm’s 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 .