Attachment 5 Experience Questionnaire (2 pages).pdf

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Attached to
Oxford MS Hydrological Laboratory, Janitorial Services
Solicitation number
12445022Q0006
Issued by

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File Type Posted
Attachment 1 Schedule of Items (2 pages).pdf PDF
Attachment 2 SCA Wage Determination 2015-5157 Rev 17 27 Dec 21 (15 pages).pdf PDF
Attachment 6 Administrative Information.pdf PDF
Attachment 4 Layout and Square Footage (1 pages).pdf PDF
Attachment 3 Statement of Work 12 Jan 2022 (11 pages).pdf PDF
Attachment 7 Questions Answers 18 Jan 22 (1 page).pdf PDF
Solicitation 12445022Q0006 SRS Oxford Janitorial Services.pdf PDF

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NAME, ADDRESS, E-MAIL, & PHONE NO. TO

CONTACT FOR INFORMATION.

AWARD

AMOUNT

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Name, Address & Telephone No. Email 2. Type of Business

Company Co-Partner Non-profit Corporation Individual

3. How many years of experience do you have in this line of work Yrs

4. How many years of experience as a prime contractor subcontractor

5. List no more than 5 most relevant projects your business has performed within 3 years of this solicitation issuance date:

CONTRACT

NUMBER

AWARD

AMOUNT

NAME, ADDRESS, E-MAIL, &

PHONE NO. TO CONTACT

FOR INFORMATION.

DATE

COMPLETED

DESCRIPTION OF

WORK PERFORMED

6. List all of your firms current contract commitments

NUMBER

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

PERCENT

COMPLETED

7c. If "yes" to either item 7a or 7b specify location(s) and reason(s) why

8. Organization information available for this project:

a. Minimum # of employees: and Maximum # of employees:

b. Are employees regularly on your payroll: yes no

c. Specify equipment available for this contract:

d. Estimate rate of progress (such as 2.0 acres per day):

1. Minimum progress rate: Maximum progress rate

9. List the experience of the principal individuals of your business

INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK

10. Information required to complete a responsibility determination if the apparent successful offeror.

a. Credit References Company Name/Address Point of Contact Telephone number TYPE OF WORK

b. Banking Information.

Company Name/Address Point of Contact Telephone number TYPE OF WORK

11. REMARKS

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:

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