Attachment 4 - Experience Questionnaire.pdf
PDF 172 KB Posted
- Solicitation number
- 12444526Q0010
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form (FS-6300-27) used to evaluate contractor qualifications and capability for federal contract opportunities.
The form requires contractors to provide comprehensive background information including company name, address, business structure (company, corporation, co-partnership, non-profit, or individual), and years of experience in the relevant line of work and contracting as both prime and sub-contractors. Contractors must list projects completed within the last three years with contract amounts, project types, completion dates, and owner contact information. The form also requires disclosure of all concurrent contractual commitments with dollar amounts, percent completion, and contract completion dates. Contractors must declare whether they have failed to complete awarded work or had work completed via performance bond, with explanations if applicable. Additional requirements include providing minimum and maximum employee availability, confirming regular payroll status, estimating minimum and maximum progress rates, listing principal individuals' experience and qualifications, and providing detailed descriptions of all equipment and vehicles to be used including maintenance plans. The questionnaire also requires a contractor self-inspection plan describing quality assurance procedures, safety plan, information on bio-based products and materials to be used, and a proposed work schedule. The form must be completed under certification by an authorized official who attests that all statements are complete and correct and that named references are authorized to verify the contractor's capability to perform the project.
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Text version
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
UEI #_____________________
E-Mail #_____________________
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 in contracting 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
COMPLETED
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:
Previous edition is obsolete (OVER) FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
a. (1) Minimum number of employees: _____ and Maximum number of employees: _____
b. Are employees regularly on your payroll: Yes No
c. 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. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.
12. Contractor Inspection, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products & materials to be used on this project, a brief safety plan, and your planned schedule of work.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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 name 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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