Attachment 4 - Experience Questionnaire.pdf
PDF 191 KB Posted
- Solicitation number
- 1240LU26Q0054
About this file
This is a USDA Forest Service Experience Questionnaire form (2/17 version) for the Coeur d'Alene Dispatch Electrical Work contract solicitation 1240LU26Q0054 at the Idaho Panhandle National Forest.
The form requires contractors to provide detailed information about their qualifications and capacity to perform the electrical work. Key information requested includes: contractor business type and location; years of experience in the relevant line of work and contracting experience as both prime and sub-contractors; documentation of similar projects completed within the last three years with contract amounts, completion dates, and owner contact information; all concurrent contractual commitments with dollar amounts, percentage completion, and expected completion dates; history of incomplete work or performance bonds; and organization and resources available for the project, including minimum and maximum employee availability, payroll status, equipment specifications, and estimated progress rates. The form also requires detailed information on principal individuals' experience, including their names, positions, years of experience, and magnitude and type of work performed. Contractors must certify under penalty of perjury that all statements are complete and correct, and authorize references to verify their capability to perform the project. The certifying official must sign the form in ink and provide the date of submission.
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Text version
USDA Forest Service (2/17)
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 & Address)
3. Business Company 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 in contracting have you or your business had as a (a) prime contractor ________ and/or
(b) sub-contractor ______?
6. List below the SIMILAR 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 Contract for Project Information
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
Contract Amount
Dollar Amt Of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date Contract Complete d
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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:
Idaho Panhandle National Forest Title: Coeur d'Alene Dispatch Electrical Work 1240LU26Q0054
9. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (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:
Individual’s Name Present Position Years of Exp.
Magnitude and Type of Work
11. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any 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 Forest Service with any information needed to verify my capability to perform this project.
12a.Certifying Official’s Name and Title 12b. Signature (Sign in Ink) 13. Date
File details come from the government source that posted it. Updated .