Attachment 4 Experience Questionnaire.docx
DOCX document 48 KB Posted
- Solicitation number
- 1284LM26Q0049
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the USDA Forest Service to evaluate contractor qualifications for the Insecticide and Fungicide Application project at the Bigfork Tree Improvement Area on the Flathead National Forest (Solicitation Number 1284LM26Q0049). The questionnaire requires contractors to provide comprehensive information about their business experience, staffing capabilities, and past performance to demonstrate their ability to successfully execute the project.
Contractors must complete sections covering: general business information and years of relevant experience as prime and subcontractors; a list of projects completed within the last three years with contract amounts, project types, completion dates, and owner contact information; current contractual commitments running concurrently with the solicited work, including contract numbers, dollar amounts, percentage completion, and completion dates; disclosure of any past failures to complete awarded work or use of performance bonds, along with on-site project visits; available employees (minimum and maximum numbers) and equipment with estimated rates of progress in measurable terms; and detailed information on principal individuals directly involved in the contract, including their positions, years of experience, and work magnitude and type. The form also includes a certification section requiring the certifying official to attest that all statements are complete and correct. Contractors must submit quotes by April 20, 2026, to Sarah.Cotton@usda.gov in PDF or Word format, along with pricing on SF-18, a Quality Control Plan, and this completed Experience Questionnaire.
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Text version
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 |
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Microsoft_Word_Document.docx
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:
Contract Number
Dollar Amt. of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date Contract 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
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