ATTACHMENT 4 Relevant Experience Questionnaire.doc
DOC document 83 KB Posted
- Attached to
- Cheoah and Tusquitee Ranger Districts Water Testing and Monitoring at Nantahala National Forest NC
- Solicitation number
- 12444126Q0010
- Issued by
-
Department of Agriculture Forest Service
About this file
The attached document is a Relevant Experience Questionnaire for Solicitation 12444126Q0010, a water testing and monitoring project for the Cheoah and Tusquitee Ranger Districts of Nantahala National Forest in North Carolina. The solicitation, issued by the Department of Agriculture Forest Service, requires contractors to submit a comprehensive questionnaire detailing their business experience, including years of work in the relevant field, previous project history, and key personnel qualifications.
Proposals are due on Wednesday, January 28, 2026, at 11:00 AM EST, to be emailed to Contract Specialist Ioulia Boxley. Contractors must submit three key documents: 1) Schedule of Items, 2) Technical Proposal, and 3) the Relevant Experience Questionnaire. The form requires detailed information about completed projects within the last three years, including contract numbers, award amounts, client details, work descriptions, and contact information. Contractors must also provide information about their business type, years of experience, credit references, and banking information, and certify the accuracy of their submission.
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Text version
AG-4670-S-16-0117
ATTACHMENT 5
RELATIVE EXPERIENCE QUESTIONNAIRE
12444126Q0010
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, using the title “Relevant Experience Questionnaire”
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business
__Company __Co-Partner __Non-profit
__Corporation __Individual
3. How many years experience do you have in this line of work ____Yrs
4. How many years experience as a prime contractor _____ subcontractor ___
5. LIST OF RELEVANT 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: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
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 6a or 6b 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. (NOTE: Only POC information is required. Please do NOT provide your account information.)
| Company Name/Address |
| Point of Contact |
| Telephone number |
9. REMARKS (Additional sheets may be attached, using the title “Relevant 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: |
File details come from the government source that posted it. Updated .