Attachment 4_Experience Questionnaire.pdf
PDF 149 KB Posted
- Solicitation number
- 12444026Q0039
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Relevant Experience Questionnaire form (Attachment 4, Solicitation 12443922Q0016) used by the Forest Service to evaluate contractor qualifications and past performance capabilities.
The questionnaire requires contractors to provide comprehensive information about their business experience and financial responsibility. Contractors must supply basic company information including name, address, contact details, business type (company, corporation, co-partner, non-profit, or individual), CAGE code, and DUNS number. The form requests years of experience in the relevant line of work and years of experience as both prime contractors and subcontractors. The core of the questionnaire requires listing up to nine relative projects completed within the last three years, with each project entry requiring the contract number, award amount, client name and address, contact information, detailed description of work performed (including specific tasks, equipment used, and safety requirements), and completion dates. The questionnaire emphasizes that project titles alone are insufficient; descriptions must include grounds maintenance, erosion control, mulching, forestry work, equipment specifications, and other relevant details to enable government evaluation. Additional sections address work completion history (questions 6a-6b), requiring disclosure of any failed projects or those completed by performance bond with explanations of reasons and locations. The form requests information on key personnel and their experience, credit references with specific materials or services provided, and banking contact information (without account numbers). A certification section requires the signatory to attest that all statements are complete and correct and that named references are authorized to verify the contractor's project performance capability. Additional space is provided for remarks, and supplementary sheets may be attached.
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Text version
12443922Q0016
ATTACHMENT 4
RELEVANT EXPERIENCE QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email 2. Type of Business Company Co-Partner _ Non-profit Corporation Individual
CAGE: DUNS:
3. How many years experience do you have in this line of work Years
4. How many years experience as a Prime Contractor Subcontractor
5. LIST OF RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST
THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included.
(i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number: Award Amount:
Client/Company’s Name/Address:
Contact Name and Telephone number:
Description of Work Performed:
Date completed or scheduled for completion:
Contact Name and Telephone number: _
6a. Have you ever failed to complete any work awarded to you? Yes No
6b. Has work ever been completed by performance bond? Yes No
6. If "yes" to either item 7a or 7b specify location(s) and reason(s) why:
7. List the experience of the principal individuals of your business:
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References:
Company Name/Address Point of Contact Telephone number Materials/Services Provided
b. Banking Information. (please do NOT provide account information – just a point of contact and a way to reach them) Company Name/Address Point of Contact Telephone number
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
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:
Any Additional Information:
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