Attachment 5 Prior Experience Questionnaire.doc
DOC document 83 KB Posted
- Attached to
- Amendment 0001 Puerto Rico-191 Water System Reconstruction Federal contract opportunity
- Solicitation number
- 12441923R0044
- Issued by
- Department of Agriculture Forest Service
About this file
This document is a relative experience questionnaire for contractors bidding on Amendment 0001 to the Puerto Rico-191 Water System Reconstruction solicitation from the Department of Agriculture Forest Service. The questionnaire collects information on the bidding contractor's experience, including the number of years in business and as a prime or subcontractor, as well as details on up to five relevant past projects including contract numbers, award amounts, client details, descriptions of work performed, and completion dates. It also requests information on any past project failures, performance bonds, principal personnel experience, credit and bank references for a responsibility determination.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 6 RFP Questions and Responses.pdf | ||
| SF 30 RFP 12441923R0044 Amendment 0001.pdf | ||
| Attachment 7 Site Visit Attendees 14-Aug-2023.pdf | ||
| Attachment 1 Schedule of Items.xlsx | XLSX spreadsheet | |
| Attachment 3 Drawings.pdf | ||
| Attachment 4 Specifications.pdf | ||
| SF 1442 RFP 12441923R0044.pdf | ||
| Attachment 2 Statement of Work.pdf |
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Text version
AG-4670-S-16-0138
ATTACHMENT 3
RELATIVE EXPERIENCE QUESTIONNAIRE
Project: FS Water System SOL #:12441923R0044 Location: PR-91 Puerto Rico
ATTACHMENT # 4
RELATIVE EXPERIENCE QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business
__Company __Co-Partner __Non-profit
__Corporation __Individual
CAGE: SAM:
3. How many years experience do you have in this line of work____Yrs
4. How many years experience as a prime contractor_____ subcontractor___
5. LIST OF RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE (3) YEARS (or list the type of equipment). Feel free to use a different form/listing but ensure references are listed and point of contact for bank is listed NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________
Perfromed as the following: Prime:_____ Subcontractor:_____ Joint Venture (JV):_____ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Perfromed as the following: Prime:_____ Subcontractor:_____ Joint Venture (JV):_____ Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6b. Has work ever been completed by performance bond? __yes __ no
6. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
7. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| Materials/Services Provided |
b. Banking Information. (please do NOT provide account information – just a point of contact and a way to reach them)
| Company Name/Address |
| Point of Contact |
| Telephone number |
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
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:
Name:
| Title: |
| Date: |
File details come from the government source that posted it. Updated .