Attachment 5 -Experience Questionnaire.pdf
PDF 490 KB Posted
- Solicitation number
- 1240LU26Q0127
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for federal contract opportunities.
The questionnaire requires contractors to provide comprehensive background information including company name, contact details, business type (company, corporation, partnership, individual, or non-profit), and years of experience in the relevant line of work. Contractors must document their experience as prime contractors and subcontractors, list similar projects completed within the last three years with contract amounts, federal contract numbers where applicable, project types, completion dates, and contact information for verification. The form requires disclosure of any failed work completion or performance bonds, with detailed explanations if applicable. Additionally, contractors must specify the minimum and maximum number of employees available for the project, confirm whether employees are on regular payroll, and itemize equipment available for contract performance. The questionnaire requests detailed information about principal business individuals including their names, cities of residence, current positions, years of experience, and the magnitude and type of work they have performed. Section 10 provides space for remarks and additional documentation to clarify responses. The form concludes with a certification statement requiring the certifying official to attest under oath that all provided information is complete and correct, with signatures in ink, official title, and date. The completed form should be submitted to the Forest Service PPS office located at 1019 N 5th Street, Custer, South Dakota 57730.
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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
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