Attachment 5 Factor 1 Experience Questionnaire for Tradeoff Source Selection.docx
DOCX document 25 KB Posted
- Solicitation number
- 1240LU24Q0012
- Issued by
-
Department of Agriculture Forest Service
About this file
This document contains an experience questionnaire for a federal construction solicitation. The solicitation is for the Devil Creek Wellhead and Water System Construction project located on the Flathead National Forest in Montana. Work includes excavation and backfill for buildings, pre-cast concrete utility building installation, MEP wellhead replacement, and utility equipment and water system connection. Responses are due no later than March 20, 2024. This is a 100% small business set-aside with an estimated construction cost between $25,000 and $100,000. The applicable NAICS code is 237110. Offerors must submit both price and technical proposals to the Contract Specialist for the USDA Forest Service by the specified due date.
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OFFEROR RESPONSE TO FACTOR 1 – EXPERIENCE (a) and (b) RFQ #1240LU24Q0012 Devil Creek Water System Construction Project Page 1
OFFEROR RESPONSE TO FACTOR 1 - EXPERIENCE RFQ #1240LU24Q0012
Devil Creek Water System Construction Project
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: Factor 1 – Experience (a): Complete Blocks 1 through 10. If additional spaces are needed for supporting information, use the space on Page 3 of this Questionnaire and provide the associate Block Number.
1. Contractor Name, Address, and Telephone Number
2. Submitted to (Office Name and Address)
3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual
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 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:
| Total Value |
| Description or Title of Project |
| Date Completed |
| Name, & Telephone No. of |
Owner/Person to Contact for Project Information
7. List below your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| Contract, Task Order or Purchase Order Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business Owner or Government Agency Involved |
| Subcontractor or Prime Contractor |
| Percent Completed |
| Date Completed |
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. Has contracted work ever been terminated for default? [ ] Yes [ ] No 8d. If “Yes” to either item 8a.,8b., or 8c., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED – PAGE 2
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:______________________________________________________
| Item No. | |
| Work Description | |
| Estimated |
No. of Days to Complete Estimated Hrs of Onsite Work Per Day Starting Time and End Time
| 0001 |
| Mobilization |
| 0002 |
| Excavation and Backfill for Buildings |
| 0003 |
| Precast Concrete Utility Building Installation |
| 0004 |
| MEP Wellhead Replacement, Utility Equipment, and Water System Connection |
d. Estimate progress rates for work items of this project:
10. List below the experience of the principal individuals of your business: (Who will directly be involved in this Purchase Order?)
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Provide response to Factor 1 – Experience (b): Narrative detailing experience the offeror has, either as a Prime Contractor (GC) or as a Subcontractor, of work similar in nature and scope to geographical conditions similar to this requirement (for example, remote location; damp climate; similar logistical challenges for transporting equipment and material; and/or care and feeding of crew; etc.). Attach sheets if extra space is needed to fully address this factor (b), and specify that the extra sheet(s) is for Factor 1 – Experience (b).
EXPERIENCE QUESTIONNAIRE CONTINUED – PAGE 3
NOTE: PLEASE PROVIDE BELOW ANY ADDITIONAL INFORMATION TO SUPPORT BLOCKS 1 THROUGH 10 OF THIS FORM 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 OF OFFEROR AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
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