Attachment 5 - Experience Questionnaire.pdf
PDF 490 KB Posted
- Attached to
- Moscow Research Station sewer line repair
- Solicitation number
- 1240LU26Q0072
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form designed to collect contractor qualification and background information for federal contract opportunities.
The questionnaire requires contractors to provide comprehensive details about their organization and experience, including contractor name and contact information, business type classification (company, corporation, partnership, individual, or non-profit), and years of experience in the relevant line of work. Contractors must document their experience as both prime and sub-contractors and list completed or ongoing projects from the past three years that demonstrate capability in similar work, including contract amounts, federal contract numbers if applicable, completion dates, and project references. The form requires disclosure of any work failures or performance bond completions, with specific explanations of locations and reasons if applicable. Additionally, contractors must detail organizational capacity by specifying minimum and maximum employee availability, confirming regular payroll status, and listing all equipment available for contract performance. Section 9 requests detailed information on principal individuals within the business, including their names, city of residence, current positions, years of experience, and the magnitude and type of work they have performed. The form includes a certification section requiring the certifying official's signature in ink, name, title, and date, whereby the contractor attests that all statements are complete and correct to the best of their knowledge and that named references are authorized to provide verification information to the Forest Service. The submission address is USDA Forest Service PPS, 1019 N 5th Street, Custer, South Dakota 57730.
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Other files
| File | Type | Posted |
|---|---|---|
| site plan.pdf | ||
| 1240LU26Q0072 Amendment 1.pdf | ||
| leak photo.pdf | ||
| Google photo.docx | DOCX document | |
| Attachment 2 - Schedule of Items.pdf | ||
| Attachment 3 -Statement of Work.pdf | ||
| Attachment 4 -Wage Determinations id65.pdf | ||
| 1240LU26Q0072 Moscow RS sewer repair.pdf |
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, email Address, and phone number
2. Submitted to (Office Name & Address) 3. Business type 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 in contracting 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 (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount & Federal Contract # if applicable
Type of Project Ongoing or
Date Completed
Person to Contact for Project Information include email or phone #
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 item 7a or 7b specify location(s) and reason(s) why:
Forest Service PPS 1019 N 5th St Custer, SD 57730
8. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________
b. Are employees regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
File details come from the government source that posted it. Updated .