Attachment 5 Experience Questionnaire.docx
DOCX document 48 KB Posted
- Solicitation number
- 1284LM26Q4000
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire template used by the USDA Forest Service to evaluate contractor qualifications and capacity for land management projects. The form captures essential contractor information including business type, years of experience as prime and subcontractors, and a three-year project history with contract amounts, completion dates, and client references. It requires disclosure of concurrent contractual commitments with completion percentages and dates, and asks whether the contractor has failed to complete previous work or required performance bonds.
The questionnaire also addresses project-specific capacity by requesting the minimum and maximum number of employees available, confirmation of regular payroll status, equipment specifications, and estimated rates of progress (measured in units such as acres per man-day). A critical section requires listing principal individuals who will directly work on the contract, including their positions, years of experience, and types of work performed. The form includes a certification statement in which the submitting official attests to the accuracy of all statements and authorizes the Forest Service to verify capability through named references. This questionnaire is used in conjunction with the Land Management Integrated Resources (LMIR) National BPA, a multiple-award blanket purchase agreement available to 43 pre-approved contractors for various natural resources restoration, engineering, project management, and related services across all National Forests and Grasslands.
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Text version
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:______________________________________________________
d. Estimate rate of progress below (such as 2.0 acres/man/day):
(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________
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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Microsoft_Word_Document.docx
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:______________________________________________________
d. Estimate rate of progress below (such as 2.0 acres/man/day):
(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________
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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