Attachment 5 Experience_questionaire.pdf
PDF 122 KB Posted
- Attached to
- Washburn Ranger District Heat and Pump Repair
- Solicitation number
- 12444626Q0019
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience and Capability Questionnaire form (OMB Clearance Number 9000-0142) used by the Forest Service to evaluate contractor qualifications for federal contract opportunities.
The questionnaire collects comprehensive information about a contractor's business profile, experience, and resources. Respondents must provide their company name, address, telephone number, and business type (company, corporation, non-profit organization, co-partner, or individual). The form requires documentation of years of experience in the relevant field, experience as both prime contractors and subcontractors, and a detailed listing of projects completed within the past three years, including contract amounts, project types, completion dates, and reference contacts. Contractors must also disclose all current contract commitments with contract numbers, amounts, project descriptions, and estimated completion dates. The questionnaire specifically addresses performance history through questions about incomplete work and performance bonds, requiring explanations of any failures or bond invocations. Additionally, the form requests information on organizational capacity, including minimum and maximum employee availability, payroll status, equipment available for the contract, and estimated progress rates where applicable. Section 9 requires a list of principal individuals involved in the business with their titles, years of experience, and types of work performed. The form includes a remarks section for additional information and concludes with a certification statement in which the signatory attests to the accuracy and completeness of all provided information and authorizes references to verify capability to perform the project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT C UPDATED SOI_Washburn Heat Pump Repair 03 03 2026.xlsx | XLSX spreadsheet | |
| UPDATED SOI_Washburn Heat Pump Repair 03 03 2026.xlsx | XLSX spreadsheet | |
| ATTACHMENT A Solicitation Terms and Conditions Part 12 Combined Synopsis Solicitation.pdf | ||
| ATTACHMENT B SCOPE OF WORK.pdf | ||
| ATTACHMENT C SOI WASHBURN PUMP REPAIR.xlsx | XLSX spreadsheet |
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Text version
EXPERIENCE AND CAPABILITY QUESTIONNAIRE
Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items.
1. Contractor's Name, Address & Telephone Number 2. Type of Business
____ Company
____ Corporation
____ Non-profit Organization
____ Co-partner
____ Individual
3. How many years of experience do you have in this line of work? ___________________
4. How many years of experience as a prime contractor? _________ subcontractor? ________
5. List the projects your business has completed in the last 3 years.
Contract
Amount
Type of Project Date
Completed
Name and Telephone Number to
Contact For Information
6. List all of your firm's current contract commitments.
Contract
Number
Contract
Amount
Type of Project Est. Date of
Completion
Name and Telephone Number to
Contact For Information
7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no
7b. Has work ever been completed by performance bond? ____ yes ____ no
7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
EXPERIENCE AND CAPABILITY QUESTIONNAIRE -- OMB Clearance Number 9000-0142
8. Organization that will be available for this project:
a. Minimum No. of employees: _______________ Maximum No. of employees: ________________
b. Are employees regularly on your payroll? ____ yes ____ no
c. If applicable, specify equipment available for this contract:
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: __________________________ Maximum progress rate: ____________________________
9. List the experience of the principal individuals of your business.
Individual's Name Present Position Years Experience Type of Work
10. Remarks:
CERTIFICATION: I certify that all of the statements made above are complete and correct to the best of my knowledge and that ny persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
Signature Title Date
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