ATTACHMENT 6 Experience Questionaire.docx
DOCX document 68 KB Posted
- Attached to
- Athens HVAC Maintenance Federal contract opportunity
- Solicitation number
- 12445023Q029
- Issued by
- Department of Agriculture Forest Service
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_12445023Q0029_Amd_0001.pdf | ||
| Sol 12445023Q0029 6.20.2023a.pdf | ||
| ATTACHMENT 1 Athens HVAC Pricing Abstract (25 May 23).xlsx | XLSX spreadsheet | |
| ATTACHMENT 2 Wage Determination 2015-4469 Rev 20 Date of Last Rev 12.27.2022 Athens HVAC Maintenance.pdf | ||
| ATTACHMENT 3 Athens HVAC Maint Statement Of Work 25 May 23.pdf | ||
| ATTACHMENT 4 Athens HVAC Maintenance List of Sustainable Products 01272021.pdf | ||
| ATTACHMENT 5 Athens NB and SB HVAC Layout and Square Footage.pdf |
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Text version
Solicitation No: 12445023Q0029 Athens HVAC Maintenance Attachment 6
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
| 1. Contractors Name, Address & Telephone No. Email | |
| 2. Type of Business | |
| Company | Co-Partner Non-profit |
Corporation Individual
| 3. How many years of experience do you have in this line of work | Yrs |
| 4. How many years of experience as a prime contractor | subcontractor |
5. List no more than 3 most relevant projects your business has performed within 3 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION. |
| DATE |
CONTRACT
COMPLETED
DESCRIPTION OF WORK PERFORMED
6. List all of your firms current contract commitments CONTRACTNAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION.
PERCENT
AWARD AMOUNT
NUMBER
| 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
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: yes no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
b. Banking Information.
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
11. REMARKS
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: |
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