Attachment 5 Experience Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 1284LM26Q0012
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the USDA Forest Service to evaluate contractor qualifications and capability for a federal contract opportunity.
The form requires prospective contractors to provide comprehensive background information including business type, years of experience in the relevant field, and a history of completed projects within the last three years with contract amounts, project types, completion dates, and owner contact information. Contractors must disclose all concurrent contractual commitments, including contract numbers, dollar amounts, percentage completion, and completion dates. The questionnaire also requires disclosure of any instances where work was not completed, whether performance bonds were used, and confirmation of on-site project visits. Additionally, contractors must specify the minimum and maximum number of employees available for the project, clarify employment status, list required equipment, and provide detailed experience of principal individuals who will directly work on the contract, including their positions, years of experience, and the magnitude and type of work performed. The form includes a certification section where the submitting official must sign under penalty of perjury, confirming the accuracy and completeness of all statements provided and authorizing the Forest Service to verify capability through named references.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 3 Appendix A Inspection Checklist.pdf | ||
| Attachment 1 Solicitation Terms and Conditions.docx | DOCX document | |
| Attachment 4 Wage Determination.pdf | ||
| Attachment 2 Performance Work Statement.doc | DOC document |
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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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