Attachment 4_Experience Questionnaire.pdf
PDF 149 KB Posted
- Solicitation number
- 12444026Q0061
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Relevant Experience Questionnaire template used by the Forest Service for federal contract solicitation 12443922Q0016. The form is designed to collect comprehensive information about a contractor's qualifications and past performance to evaluate their capability to perform contract work.
The questionnaire requires contractors to provide: company information including business type, CAGE and DUNS numbers, and years of experience in the relevant line of work and as prime or subcontractors. Contractors must list at least five relative projects completed within the last three years, with detailed descriptions including contract numbers, award amounts, client contact information, specific work performed (tasks, equipment used, safety requirements), and completion dates. The government explicitly requires sufficient detail beyond project titles to enable proper evaluation. Additional sections request information about principal individuals' experience and qualifications, past performance issues (failures to complete work or performance bond completions with explanations), credit references, and banking contact information. The form includes a certification statement requiring the signatory to confirm that all statements are complete and correct and that named references are authorized to provide verification information to the Forest Service. The questionnaire permits attachment of additional sheets if needed for comprehensive responses.
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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:
File details come from the government source that posted it. Updated .