ATTACHMENT 4 - Relevant Experience Questionnaire.docx
DOCX document 32 KB Posted
- Attached to
- Potable Water Testing and Wastewater Inspection - Pisgah and Grandfather Ranger Districts
- Solicitation number
- 12444124R0007
- Issued by
-
Department of Agriculture Forest Service
About this file
This document contains a relative experience questionnaire and details of a related federal contract opportunity for potable water testing and wastewater inspection services. The opportunity is a base plus four option year contract issued by the Department of Agriculture Forest Service to support their Drinking Water Program. Services required include collection of water samples, laboratory testing for potability, and wastewater system inspections for two National Forest districts in North Carolina. Testing and inspections must comply with all state and federal regulations. The questionnaire collects contact, experience, and reference information from offerors to evaluate responsibility. Relevant experience, including as a prime contractor or subcontractor, is to be detailed for the last three years along with performance history. The contract will be awarded to the responsible offeror whose conforming proposal is most advantageous to the Government, considering price and other factors.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 3 - Wage Determination 2015-4417 R23.pdf | ||
| ATTACHMENT 1 - Schedule of Items.pdf | ||
| ATTACHMENT 2 - Statement of Work.pdf | ||
| RFP 12444124R0007.pdf |
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Text version
AG-4670-S-16-0138
ATTACHMENT 3
RELATIVE EXPERIENCE QUESTIONNAIRE
12444124R0006
ATTACHMENT 6
RELATIVE 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____Yrs
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: ______________________________________________________________
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 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: |
File details come from the government source that posted it. Updated .