Attachment 5 Experience Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 1284LM25Q0013
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is an Experience Questionnaire for a USDA Forest Service contract solicitation for dust palliative application services. The form requires potential contractors to provide detailed information about their business experience, including years in similar work, past project completions, current contractual commitments, employee availability, and key personnel qualifications. The questionnaire seeks to evaluate a contractor's capability to perform road dust suppression work across national forests in northern Idaho and western Montana, specifically the Lolo, Flathead, Kootenai, Bitterroot, and Idaho Panhandle National Forests.
Key submission details include the solicitation number 1284LM25Q0013, with questions due by April 4, 2025, to be sent to joanne.meiers@usda.gov. The contractor will be responsible for providing all necessary equipment, operators, supplies, and support functions for applying calcium chloride dust palliative materials on forest roads. The questionnaire requires contractors to certify the accuracy of their submitted information and provides space for detailing their business structure, past performance, available resources, and key personnel experience relevant to the dust suppression road maintenance project.
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Other files
| File | Type | Posted |
|---|---|---|
| SF-30_Amd_0002.pdf | ||
| 1284LM25Q0013 AMD 0002.docx | DOCX document | |
| SF-30_Amd_0001.pdf | ||
| 1284LM25Q0013 AMD 0001.docx | DOCX document | |
| Attachment 2 Quality Assurance Plan.pdf | ||
| Attachment 3 Special Project Specification 412.pdf | ||
| 1284LM25Q0013.docx | DOCX document | |
| Attachment 4 Vicinity Maps.pdf | ||
| Attachment 6 SCA Wage Determinations.pdf | ||
| Attachment 1 Statement of Work.pdf |
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.
1. Contractor Name, Address, and Telephone Number
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 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 Complete |
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. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:______________________________________________________
10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.
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.
12a. CERTIFYING OFFICIAL’S NAME AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
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