Attachment 5 Relevant Experience Questionnaire.pdf
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- Solicitation number
- 12444124R0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Attachment 5 Relevant Experience Questionnaire related to a federal contract opportunity solicitation. The solicitation is for Waste Treatment Services for the USDA Forest Service, National Forests in North Carolina, Croatan Ranger District, New Bern, Craven County, North Carolina.
The key details include: The solicitation is set aside for Small Businesses with a NAICS code of 562998 All Other Miscellaneous Waste Management Services. The period of performance consists of a 12-month Base Period and four 12-month Option Years. Offerors are required to submit pricing for all Line Items, including Option Years, to be considered for award. Relevant Experience information must be provided by completing the Attachment 5 Questionnaire, which requests details on the offeror's company, experience, prior projects, and key personnel. Offers are due by May 21, 2024, at 11:00AM Eastern Time, and should be submitted by email to the Contracting Officer, Tina Pettyjohn.
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Text version
12444124R0008
ATTACHMENT 5
RELEVANT EXPERIENCE (PAST PERFORMANCE) 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
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 RELEVANT PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST
THREE (3) YEARS
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: _________________________________
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: ______________________________________________________________
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 6a or 6b 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. (NOTE: Only POC information is required. Please do NOT provide your account information.)
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 .